肺癌脑转移的综合治疗临床分析

目的通过回顾性分析探讨影响肺癌脑转移治疗效果的预后因素。方法对66例非小细胞肺癌脑转移患者进行以全脑放射治疗为主,结合其他综合方法的治疗,将脑转移原发灶控制与否、脑外转移灶、单发或多发脑转移、化疗周期等因素进行多因素分析。结果所有患者经放疗后脑转移灶症状缓解率达80%,缓解期为2-50个月,中位缓解期为6个月;全脑放疗后CT或MRI显示脑转移灶局部控制率为22%;全组中位生存期6个月,1、2年生存率分别为25%和7.5%。经多因素分析显示生存率与多发脑转移、原发病灶未控呈负相关,而化疗4周期以上呈正相关。结论影响肺癌脑转移的主要因素是脑转移时原发灶控制与否、多发或单发脑转移、化疗周期数。治疗效果则由肿瘤的生物学特性、组织学、放疗敏感性、肿瘤负荷、位置、激素反应性和宿主的免疫状态决定。对原发转移、脑转移时原发灶的控制以及全身状况较好者,应采取积极的治疗。

Combined modality therapy following bladder conservation surgery for bladder cancers

OBJECTIVE: To analyze the efficacy of recurrence prophylaxis using radiation and chemotherapy following bladder conservation surgery for muscle invasive bladder cancer. METHODS: 23 patients with muscle invasive bladder cancer were treated with radiotherapy combined with bladder mitomycin infusion after bladder conservation surgery (study group). Radiotherapy was given using an external beam at an average dose of 5148 +/- 462 cGy with conventional fractionation. For comparison, 29 similar patients treated with postoperative bladder mitomycin infusion without radiation served as control (control group). All patients were followed up for more than 3 years, an average of 41.6 months (36 - 60 months). RESULTS: The 3-year pelvic recurrent rate of muscle invasive bladder cancer was 17.4% in the study group and 44.8% (P = 0.036) in the control group. The 3-year distant metastasis rates were 17.4% and 24.1%, respectively (P = 0.554). The 3-year overall survival rates were 81.8% and 86.2%, respectively (P = 0.670). Two patients from the study group had their treatment interrupted, one for 3 days and the other for one week due to acute cystitis, while the rest of the patients were able to complete the treatment according to schedule. CONCLUSION: Radiotherapy plus chemotherapy after bladder conservation surgery for muscle invasive bladder cancer can decrease the rate of pelvic recurrence effectively and be used as a realistic adjuvant treatment.

Combined modality therapy following bladder conservation surgery for bladder cancers

To analyze the efficacy of recurrence prophylaxis using radiation and chemotherapy following bladder conservation surgery for muscle invasive bladder cancer Methods 23 patients with muscle invasive bladder cancer were treated with radiotherapy combined with bladder mitomycin infusion after bladder conservation surgery (study group) Radiotherapy was given using an external beam at an average dose of 5148±462 cGy with conventional fractionation For comparison, 29 similar patients treated with postoperative bladder mitomycin infusion without radiation served as control (control group) All patients were followed up for more than 3 years, an average of 41 6 months (36-60 months) Results The 3 year pelvic recurrent rate of muscle invasive bladder cancer was 17 4% in the study group and 44 8% ( P =0 036) in the control group The 3 year distant metastasis rates were 17 4% and 24 1%, respectively ( P =0 554) The 3 year overall survival rates were 81 8% and 86 2%, respectively ( P =0 670) Two patients from the study group had their treatment interrupted, one for 3 days and the other for one week due to acute cystitis, while the rest of the patients were able to complete the treatment according to schedule Conclusion Radiotherapy plus chemotherapy after bladder conservation surgery for muscle invasive bladder cancer can decrease the rate of pelvic recurrence effectively and be used as a realistic adjuvant treatment