奥沙利铂联合氟尿嘧啶同期调强适形放疗治疗局部晚期鼻咽癌疗效观察

【目的】探讨奥沙利铂联合氟尿嘧啶同期调强适形放疗治疗局部晚期鼻咽癌的临床疗效。【方法】选自本院于2012年5月至2014年5月期间收治的局部晚期鼻咽癌患者82例，依据随机数表法分为观察组与对照组各41例。两组患者均采用三维调强适形放疗。对照组在调强放疗基础上同期采用顺铂化疗，观察组在调强放疗基础上同期采用奥沙利铂联合氟尿嘧啶化疗。两组均以21d为1个周期，连续2～4个周期。比较两组近期疗效，1年和3年局部复发情况、远处转移情况和生存情况及毒副反应发生情况。【结果】两组近期总有效率均为100，00％，差异无统计学意义（P〉0．05）；两组1年局部复发率比较无统计学差异（P〉0．05）。观察组3年局部复发率低于对照组（P〈0．05）；两组1年远处转移率比较无统计学差异（P〉0．05）；观察组3年远处转移率低于对照组（PG0．05）；两组胃肠反应、肝功能、肾功能及口腔黏膜反应发生率比较差异无显著性（P〉0．05）；两组1年生存率比较无统计学差异（P〉O．05）；观察组3年生存率高于对照组（PG0．05）。【结论】奥沙利铂联合氟尿嘧啶同期调强适形放疗对局部晚期鼻咽癌患者疗效显著，可降低局部复发和远处转移，延长生存时间，值得临床推广应用。

力扑素加草酸铂联合放疗治疗局部晚期鼻咽癌临床疗效观察

目的:观察力扑素加草酸铂化疗方案联合放疗治疗晚期鼻咽癌的临床疗效以及不良反应。方法:126例Ⅲ、Ⅳa期鼻咽低分化鳞癌患者,随机分为研究组和对照组,研究组64例,对照组62例。研究组给予力扑素加草酸铂化疗联合根治性放疗;对照组给予紫杉醇加草酸铂化疗联合根治性放疗。观察两组的近期疗效以及不良反应。结果:力扑素加草酸铂放化疗组的疗效与紫杉醇加草酸铂放化疗组没有统计学差异,呼吸困难、皮肤潮红、肌肉酸痛等不良反应的发生率明显低于对照组,差异有统计学意义。结论:力扑素加草酸铂化放疗方案过敏反应较紫杉醇加草酸铂方案明显减少。

几种不同方法治疗区域晚期鼻咽癌的疗效比较

【目的】比较三种不同治疗方法治疗区域晚期鼻咽癌方法的效果，寻找最佳的临床治疗路径。【方法]2000年3月至2005年2月，采取化疗、放疗和放化疗相结合三种方法治疗区域晚期鼻咽癌145例，并比较各组患者无瘤生存时间。【结果】三组无瘤生存时间在36个月内差异无显著性（P〉0．05），36～60个月内差异有显著性（P〈0．05），60个月以上差异有显著性（P〈0．01）。化疗组与放疗组相近，两组均优于放疗组。主要因素是放疗组远处转移率高（32．31％）。【结论】化疗能提高区域晚期鼻咽癌无瘤生存时间。

功能磁共振成像在鼻咽癌的诊治上的应用

鼻咽癌（N PC ）是一种南方地区常见的且原发部位比较隐蔽的恶性肿瘤，病变的早发现、早诊断对预测治疗疗效和预后以及N PC的治疗具有重要的意义。磁共振成像（magnetic resonance imaging ， M RI ）作为一种无辐射并能进行多参数成像和多层面扫描的无创影像检查方法，受到越来越多医师和患者的认可，并且成为N PC诊断的首选影像学检查方法。近年来功能性磁共振成像作为一种新的检查技术在临床上广泛应用，其中主要包括弥散加权成像（diffusion‐weighted imaging ，DWI ）、灌注成像（perfusion weighted imaging ，PWI）等，其通过检测组织微环境改变、代谢情况及血流动力学等信息来诊断疾病、判断疾病的发展与转归，即能在分子水平来研究疾病发生、发展与转归，从而改变了单纯通过形态学改变来诊断的传统方法，相信在今后的影像检查中会起到越来越重要的作用。笔者就近年来功能磁共振在N PC中的临床应用及价值综述如下。

熟地黄多糖联合同步放疗对鼻咽癌增殖转移的影响研究

目的:探究熟地黄多糖联合同步放疗对鼻咽癌增殖转移的影响。方法:160例符合要求的鼻咽癌患者根据入院单双日进行匹配,均分为对照组(顺铂单药进行同步放疗)与实验组(同步放疗基础上使用熟地黄多糖进行联合治疗),比较两组患者治疗前后,CNE细胞增殖抑制率、Caspase-3含量、淋巴细胞亚群、细胞因子及抗体含量的统计学差异。结果:两组患者治疗前后CNE细胞生长抑制率、Bcl-2、Bax、Caspase-3 mRNA表达含量、CD80和CD86阳性率差异有统计学意义(P<0.05),随着时间迁移,CNE细胞生长抑制率、Bax、Caspase-3 mRNA表达含量呈现显著上升趋势,Bcl-2表达含量、CD80和CD86阳性率呈现显著下降趋势。治疗4周和治疗8周后比较实验组CNE细胞生长抑制率、Bax、Caspase-3 mRNA表达含量显著高于对照组,Bcl-2表达含量、CD80和CD86阳性率显著低于对照组。实验组临床疗效显著优于对照组(P<0.05)。结论:熟地黄多糖联合同步放疗对鼻咽癌治疗效果更佳,值得临床推广。

Signal intensity changes of dentate nucleus on plain MR T1WI innasopharyngeal carcinoma patients after radiotherapy andmultiple injections of gadolinium-base contrast agent

Objective To observe changes of plain MR T1WI signal intensity of dentate nucleus in nasopharyngeal carcinoma patients after radiotherapy and multiple times of intravenous injection of gadolinium-based contrast agent(GBCA).Methods Fifty patients with pathologically confirmed nasopharyngeal carcinoma and received intensity-modulated radiotherapy were retrospectively enrolled as the nasopharyngeal carcinoma group,and 50 patients with other malignant tumors and without history of brain radiotherapy were retrospectively enrolled as the control group.All patients received yearly GBCA enhanced MR examinations for the nasopharynx or the head.T1WI signal intensities of the dentate nucleus and the pons on same plane were measured based on images in the year of confirmed diagnosis(recorded as the first year)and in the second to the fifth years.T1WI signal intensity ratio of year i(ranging from 1 to 5)was calculated with values of dentate nucleus divided by values of the pons(ΔSI i),while the percentage of relative changes of year j(ranging from 2 to 5)was calculated withΔSI j compared toΔSI 1(Rchange j).The values of these two parameters were compared,and the correlation ofΔSI and GBCA injection year-time was evaluated within each group.Results No significant difference of gender,age norΔSI 1 was found between groups(all P>0.05).The second to the fifth yearΔSI and Rchange in nasopharyngeal carcinoma group were all higher than those in control group(all P<0.05).Within both groups,ΔSI was positively correlated with GBCA injection year-time(both P<0.05).Conclusion Patients with nasopharyngeal carcinoma who underwent radiotherapy and multiple times of intravenous injection of GBCA tended to be found with gradually worsening GBCA deposition in dentate nucleus,for which radiotherapy might be a risk factor.

局部晚期鼻咽癌患者放化综合治疗临床观察

目的:探讨Ⅲ、ⅣA期鼻咽癌患者放化综合治疗的疗效和影响预后因素。方法:选取符合入组条件的Ⅲ、ⅣA期初治鼻咽癌患者156例,分为单纯放疗组(78例)和放化综合治疗组(78例)。用Kaplan-Meier方法计算生存率,用Cox比例风险模型分析预后影响因素。结果:单纯放疗组的3年总生存率为42.8%(33/78),放化疗综合治疗组为75.9%(59/78),两组比较差异有统计学意义,P=0.007。临床分期、N分期、是否化疗、治疗后是否残留是影响鼻咽癌患者生存的相关因素。结论:放化综合治疗对Ⅲ、ⅣA期鼻咽癌效果较好。

治疗前PLR与NLR在评估新疆维吾尔族鼻咽癌预后价值中的初步探讨

目的 探讨治疗前外周血血小板与淋巴细胞比值（PLR）以及中性粒细胞与淋巴细胞比值（NLR）和新疆维吾尔族鼻咽癌预后的关联性.方法 回顾分析96例病理诊断明确的新疆维吾尔族鼻咽癌患者的临床资料,通过受试者工作特征（ROC）曲线确定PLR、NLR最佳截点值,根据PLR、NLR最佳截点值分别将患者分为高PLR组和低PLR组、高NLR组和低NLR组,利用Kaplan-Meier法计算生存率,Log-rank检验比较不同组间的差异,采用Cox回归分析对可能影响新疆维吾尔族鼻咽癌患者预后的因素进行分析.结果 高PLR组与低PLR组5年总生存率、无进展生存率分别为46.6％和79.3％,49.8％和82.7％,差异有统计学意义（均P＜0.01）.高NLR组与低NLR组5年总生存率、无进展生存率分别为41.3％和83.5％,50.8％和82.5％,差异有统计学意义（均P＜0.01）.单因素分析结果显示,N分期、临床分期、NLR、PLR是影响患者总生存及无进展生存的主要因素（均P ＜0.05）;对单因素分析中有统计学意义的因素进行COX多因素回归分析,结果显示,PLR及临床分期是影响新疆维吾尔族鼻咽癌患者总生存及无进展生存的独立危险因素（均P＜0.05）.结论 PLR可能是影响新疆维吾尔族鼻咽癌患者预后的独立影响因素.

鼻咽癌治疗后颈部转移癌复发漏诊误诊39例分析

目的探讨鼻咽癌治疗后颈部转移癌复发漏诊误诊原因,提高早期诊断率。方法对39例病理证实为鼻咽癌治疗后颈部转移癌复发漏诊误诊病例进行回顾性分析。结果 39例患者,彩超诊断复发8例;32例患者行MRI检查,诊断复发17例;39例行细针穿刺,诊断复发17例。结论鼻咽癌治疗后颈部淋巴癌复发存在不典型病例,在诊过程中,需倍加注意;必要时可行诊断性手术以明确诊断。

盐酸羟考酮缓释片治疗鼻咽癌黏膜反应

目的应用盐酸羟考酮缓释片治疗同步放、化疗中因急性黏膜炎所致口咽疼痛的中晚期鼻咽癌患者,观察其疗效。方法收集初诊处治的中晚期NPC病人56例,治疗组给予羟考酮缓释片治疗,同时对口咽黏膜炎进行常规治疗,对照组则仅给予常规治疗,对病人疼痛程度、治疗疼痛效果、病人生活质量给予评价。结果随着放疗剂量累积、化疗周期数的增加,羟考酮缓释片治疗组与对照组相比较:每周VAS平均分均显著低于对照组;疼痛缓解率显著高于对照组;病人生活质量显著高于对照组。结论盐酸羟考酮缓释片能够有效控制中晚期鼻咽癌同步放、化疗中放射性黏膜炎所致口咽疼痛,提高患者的生活质量,具有较高的临床应用价值。

GP方案同期放化疗治疗局部晚期鼻咽癌的近期临床观察

为了观察和比较吉西他滨联合顺铂(GP)及氟尿嘧啶联合顺铂(FP)同期放化疗治疗局部晚期鼻咽癌患者的近期疗效和耐受性,将经病理确诊的局部晚期鼻咽癌(T3-4N1-3M0)患者56例,分为GP组27例和FP组29例。GP组化疗在放疗第1,5周给予吉西他滨1000mg/m2,d1,d8+顺铂25mg/m2,d1～d3,静脉滴入。FP组化疗在放疗第1,5周给予5-FU500mg/m2,d1～d5+顺铂25mg/m2,d1～d3,静脉滴入。两组放疗方案相同,均为飞利浦直线加速器(能量为6MVX线)常规照射,鼻咽部总放疗剂量(70～72)Gy/(35～36)次,2Gy/次,颈部淋巴结总放疗剂量(60～70)Gy/(30～35)次,2Gy/次。治疗结束后行肿瘤疗效评价,GP组近期有效率为100%,CR21例;FP组有效率为96.6%,CR18例。GP组与FP组Ⅲ～Ⅵ级恶心、呕吐发生率分别为11.1%、13.8%(P>0.05),骨髓抑制发生率分别为29.6%、17.2%(P<0.05),皮肤反应发生率分别为18.5%、27.6%(P<0.05),口腔黏膜反应发生率分别为14.8%、24.1%(P<0.05)。初步研究结果提示,采用GP方案同期放化疗治疗局部晚期鼻咽癌近期疗效优于FP方案,毒副反应可耐受,值得临床应用。

MRI与CT在鼻咽癌诊断和治疗的应用价值比较

目的比较MRI与CT在揭示鼻咽癌（NPC）颅底骨破坏、椎前肌受累及咽后淋巴转移中的鉴别诊断和在放疗中的应用价值。方法经病理证实首诊的180例NPC病人同期行MRI和CT检查，对比显示鼻咽周围结构受累和颅底骨破坏情况。结果MRI示颅底骨受累率、椎前肌受累率和咽后淋巴转移率分别为71．1％、33．3％和60．0％，而CT的相应值仅35．6％、7．8％和13．3％，两者差异均有统计学意义（χ^2=45．71，35．99，13．47，P〈0．01）。结论MRI诊断鼻咽癌颅底骨、椎前肌受累及咽后淋巴转移优于CT，既有利于鼻咽癌放疗中准确勾画靶区，又可避免“漏靶”；MRI对原发灶进行评估，有利于指导临床合理治疗。

Significance of the Expression of CyclinD1 and Ki67 Antigen in Nasopharyngeal Carcinoma

Objective: To detect the expression of cyclinD1 and Ki67 in nasopharyngeal carcinoma (NPC) and their correlation with the biological behaviors and prognosis. Methods: 56 cases of biopsy specimens of NPC which had been embedded with para?n in 1996 in our hospital were collected and immunostained with cyclinD1 and Ki67 monoclonal antibodies by means of the streptavidin peroxides method. The patients were followed up periodically, and then their biological behaviors and prognosis were statistically analyzed. Results: The percentage of cyclinD1 and Ki67 positive cells in the NPC specimens ranged from 0–54% and 0–31% respectively. The staining was nuclear. Of the 56 cases, 30 cases (56.6%) highly expressed cyclinD1 or Ki67 HPI and 26 cases (46.4%) lowly expressed cyclinD1, while only 16 cases (28.6%) showed Ki67 HPI (high proliferated index) and 40 cases (71.4%) showed Ki67 LPI (low proliferated index). Patients who lowly expressed cyclinD1 or highly expressed Ki67 had a higher radiosensitivity and a better prognosis. Conclusion: CyclinD1 and Ki67 immunohistochemical staining is considered to be useful, not only as an independent factor of radiosensitivity and prognosis respectively, but also as a means of determining the optimum treatment for each individual patient with NPC.

参芪扶正联合放化疗在鼻咽癌治疗中的应用

目的观察参芪扶正联合放化疗治疗鼻咽癌疗效及不良反应。方法将30例在辽油二院住院鼻咽癌患者,随机分为实验组和对照组。实验组采用放化疗+参芪扶正。对照组为放化疗。两组放化疗剂量相似、条件相同,比较两组鼻咽癌患者在放化疗期间不良反应和对放化疗耐受性。结果实验组较对照组的疗效、生存质量均明显提高,不良反应明显减少。结论实验组明显改善了患者生存质量,减轻了化疗的不良反应,值得在临床治疗中推广应用。

咽旁间隙肿瘤43例诊疗分析

目的讨论临床上少见的咽旁间隙肿瘤的临床表现、诊断与治疗。方法对1998-01-2009-06信阳职业技术学院附属医院收治的43例咽旁间隙肿瘤患者的临床资料进行回顾性分析。结果本组病例中8例经腮腺径路,17例经颈侧径路,16例经下颌骨断开外旋径路,2例经口腔径路,均顺利切除肿瘤。术后病理结果为:腺源性肿瘤36例,神经源性肿瘤4例,其他3例;良性肿瘤33例,恶性肿瘤10例。结论完善的检查,特别是CT和MRI可提供重要的诊断依据,对手术径路的选择至关重要。恰当的手术径路可顺利和彻底的切除肿瘤,最大限度地避免并发症的发生。

Mediastinal tuberculous lymphadenitis presenting as an esophageal intramural tumor: A very rare but important cause for dysphagia

Dysphagia associated with esophageal mechanical obstruction is usually related to malignant esophageal diseases. Benign lesions are rarely a cause for this type of dysphagia, and usually occur either as an intramural tumor or as an extrinsic compression. Mediastinal tuberculous lymphadenitis is rare in adults, and even more rarely causes dysphagia. We report two cases of dysphagia in adult patients caused by mediastinal tuberculous lymphadenitis, presenting radiologicaUy and endoscopically as an esophageal submucosal tumor. Based on the clinical and imaging diagnosis, the patients underwent a right thoracotomy, and excision of the mass attached to and compressing the esophagus. Pathological examination of the specimens showed a chronic granulomatous inflammation with caseous necrosis, which was consistent with tuberculous lymphadenitis.

Comparison of efficacy between two boost treatments in residual tumor of nasopharyngeal carcinoma after radical radiotherapy

Objective： To compare the efficacy between stereotactic radiotherapy （SRT） and intracavitary brachytherapy （brachytherapy） in residual tumor of nasopharyngeal carcinoma （NPC） after treating with conventional external beam radiotherapy. Methods： 60 patients with residual tumor of NPC after radical external beam radiotherapy （range 68 to 72 Gy） were randomized into SRT group （27 patients） and brachytherapy group （33 patients）. Patients in SRT group received boost treatment of 10-20 Gy, 2-3 fractions, once every other day; patients in brachytherapy group were treated with boost 10-20 Gy, 5 Gy per fraction, twice a week. Results： Efficacy in the near future： in SRT group, the complete recession （CR）, partial recession （PR） and no change （NC） rates were 77.8% （21/27）, 18.5% （5/27）, 3.7% （1/27）, respectively and the efficacy rate was 96.3% （CR ＋ PR）; in brachytherapy group： the CR, PR and NC rates were 75.8% （25/33）, 18.2% （6/33）, 6.1% （2/33）, respectively and the efficacy rate was 93.9% （CR ＋ PR）. The efficacy rates of the above two groups were compared （x^2 = 0.032, P 〉 0.05）. Long term efficacy： in SRT group, 1-year and 3-year survival rates were 96.3%, 66.5% respectively and the median live time was 48 months; in brachytherapy group： 1-year and 3-year survival rates were 93.9%, 60.2% respectively and the median live time was 46 months. The survival rates of two groups were compared （x^2 = 0.172, P 〉 0.05）. Conclusion： Both boost techniques of SRT and brachytherapy had elevated efficacy in patients with residual tumor of NPC and there was no obvious difference between the efficacy of the near and long term in SRT and brachytherapy group.