皮肤癌放射治疗78例疗效分析

皮肤癌的治疗方式有手术、放射、药物、冷冻、激光以及电灼等,决定那种治疗方式与病变的部位、范围、病理类型、一般情况以及既往治疗史有关。现就我科1994年1月～2004年12月收治的皮肤癌78例行放射治疗和环磷酰胺外用疗效分析如下。

海藻酸钠微球介入治疗恶性肿瘤的临床研究

恶性肿瘤是常见病、多发病，传统的手术治疗只适合早期病变。近年来国内学者采用栓塞术取得较满意疗效。我们应用新型栓塞剂海藻酸钠微球（KMG）选择性的介入治疗恶性肿瘤，取得较好临床疗效，现报告如下。

新的前列腺癌治疗手册出版

为了使美国民众能够全面地了解放射治疗癌症的安全性和有效性，美国肿瘤放射治疗学会开展了新的公众意识宣传活动，其中，第一步骤就是出版发行一本新的《前列腺癌放射治疗手册》以帮助患者了解这种非手术治疗癌症的信息，从而做出有见识的治疗选择决定。

Usefulness of two independent hist classifications of tumor regression iUsefulness of two independent histopathological classifications of tumor regression in patients with rectal cancer submitted to hyperfractionated pre-operative radiotherapy

AIM： To assess the usefulness of two independent histopathological classifications of rectal cancer regression following neo-adjuvant therapy. METHODS： Forty patients at the initial stage cT3NxM0 submitted to preoperative radiotherapy （42 Gy during 18 d） and then to radical surgical treatment. The relationship between ＂T-downstaging＂ versus regressive changes expressed by tumor regression grade （TRG 1-5） and Nasierowska-Guttmejer classification （NG 1-3） was studied as well as the relationship between TRG and NG versus local tumor stage ypT and lymph nodes status, ypN. RESULTS： Complete regression （ypT0, TRG 1） was found in one patient. ＂T-downstaging＂ was observed in 11 （27.5%） patients. There was a weak statistical significance of the relationship between ＂T-downstaging＂ and TRG staging and NG stage. Patients with ypT1 were diagnosed as TRG 2-3 while those with ypT3 as TRGS. No lymph node metastases were found in patients with TRG 1-2. None of the patients without lymph node metastases were diagnosed as TRG 5. Patients in the ypT1 stage were NG 1-2. No lymph node metastases were found in NG 1. There was a significant correlation between TRG and NG. CONCLUSION： Histopathological classifications may be useful in the monitoring of the effects of hyperfractionated preoperative radiotherapy in patients with rectal cancer at the stage of cT3NxM0. There is no unequivocal relationship between ＂Todownstaging＂ and TRG and NG. There is some concordance in the assessment of lymph node status with ypT, TRG and NG. TRG and NG are of limited value for the risk assessment of the lymph node involvement.

An Overview of CyberKnife Radiosurgery

Stereotactic radiosurgery is a non-invasive procedure that utilizes precisely targeted radiation as an ablative surgical tool. Conventional radiosurgery devices, such as the Gamma Knife, rely upon skeletally attached Stereotactic frames to immobilize the patient and precisely determine the 3D spatial position of a tumor. A relatively new instrument, the CyberKnife (Accuray, Inc., Sunnyvale, CA), makes it possible to administer radiosurgery without a frame. The CyberKnife localizes clinical targets using a very accurate image-to-image correlation algorithm, and precisely cross-fires high-energy radiation from a lightweight linear accelerator by means of a highly manipulable robotic arm. CyberKnife radiosurgery is an effective alternative to conventional surgery or radiation therapy for a range of tumors and some non-neoplastic disorders. This report will describe CyberKnife technology and oncologic applications in neurosurgery and throughout the body.

^(99)Tc^m direct labeling of angiostatin

Objective: To explore the method of 99 Tc m direct labeling of angiostatin (AS) and investigate the stability and bioactivity of the 99 Tc m labeled AS in vitro . Methods: AS was extracted, validated, and then labeled with 99 Tc m after having been reduced by 2 ME or SnCl 2. The best labeling condition was screened by cross design. The labeling efficiency was measured by TLC and column chromatography. The stability of 99 Tc m AS was observed and compared when BSA, saline and different molar ratios of Cys∶AS were separately added. The bioactivity of 99 Tc m AS was observed in human umbilical vein endothelial cell (CEV304). Results: The labeling efficiency can reach (97±1 5)% for the 2 ME reducing approach. Its best experimental condition was as follows: AS 100 μg,PB(0 5 mol/L, pH 7 3)1 ml, 2 ME 100 μg, MDP (dissolved in 1 ml saline) 10 μl, and 99 Tc mO 4 - 185 MBq. The labeling efficiency using SnCl 2 reducing method can reach (90±3 0)%. The best experimental procedure was as follows: AS 100 μg,boric acid buffer(0 1 mol/L, pH 9 0)1 ml, 2%SnCl 2 (dissolved in 1 mol/L hydrochloric acid) 20 μl, was added into MDP, which was diluted with 1 ml deoxygenized water, and then 20 μl, 99 Tc mO 4 - 185 MBq was added. The product of 99 Tc m labeled AS was stable in vitro and had the same bioactivity as AS. Conclusion: 99 Tc m direct labeling of AS is simple and efficient. And the bioactivity of 99 Tc m AS has no significant change compared with AS.

Prediction of Response to Multimodality Treatment inEsophageal Cancer

Patients with locally advanced esophageal cancer have a dismal prognosis when treated exclu- sively by surgery. This fact prompted many investigators to apply neoadjuvant treatment strategies in an e?ort to improve survival. Results from phase III randomized trials are encouraging however, they revealed 五笔字型计算机汉字输入技术 that only patients with major histopathological response will bene?t from treatment. Therefore, predic- tive molecular markers indicating response or non-response to neoadjuvant treatment would be extremely helpful in selecting patients for current and future treatment protocols. In this paper we review the role of the molecular markers ERCC1 (excision repair cross-complementing 1 gene) and c-erbB-2 (synonym: HER2/neu) in predicting response to radiochemotherapy and outcome for patients with locally advanced resectable esophageal cancers (cT2-4, Nx, M0). The results are promising and it appears that we might expect to unequivocally identify with ERCC1 and c-erbB-2 respectively, approximately up to one third of patients who ful?l the criteria for neoadjuvant treatment for locally advanced esophageal cancer but will not bene?t from our treatment protocol. Integration of such markers in the clinical setting might prevent a substantial number of patients from expensive, non-e?ective and potentially harmful therapies, and could lead to a more individualized type of combined multimodality treatment in the near future.

EXTRAAXIAL SCHWANNOMA:CT AND MRI FINDINGS

Objective schwannomas in various locations To clarify the clinical, morphological and radiological features of extraaxial Methods A total of 87 patients with schwannoma were analyzed in this report. Locations of tumors included salivary gland （ n = 13 ） , tongue （ n = 2 ） , neck soft tissue （ n = 32 ）, trunk wall （ n =4 ）, mediastinum （ n = 10）, liver （ n = 1 ） , stomach （ n = 1 ）, retroperitoneum （ n = 8） , and extremities （ n = 16）. Fifty-nine contrasted CT examinations, and 38 MRI examinations were available before surgery. Results Sixty-nine percent of tumors （ 60 out of 87） were either fusiform or ovoid shaped. Well-delineated margins were observed in all 87 （100%） tumors. In this report, patterns of enhancement were diversified. The 38 MRI examinations revealed that 4 （11%） cases showed target sign; 8 （21%） cases presented fascicular sign; and 20 （53%） cases showed split fat sign. No contrast enhanced cystic or necrotic areas were observed in 52 of 87 cases （60%）. Conclusion Most schwannomas showed non-specific imaging appearances. However, recognition of the fusiform or ovoid shape, well-delineated margin of the tumor, the three signs on MRI images （ the target sign, the fascicular sign and the split fat sign）, and the cystic or necrotic areas in tumors could be helpful for diagnosis.

Giant cell tumor involving radial diaphysis

Giant cell tumor (GCT) of the bone is a benign but locally aggressive & destructive lesion. This tumor is usually seen in patients over 20 years of age. Less than 2% are found in part with open epiphysis. The epiphyseal portion of the bone is characteristic site of giant cell tumor. In rare instances, giant cell tumor can occur in the diaphysis of long tubular bone without involving the epiphysis. Although age, clinical and radiological features are helpful, it is still the histology that helps to clinch the diagnosis. It is important to distinguish giant cell tumor of diaphysis from the giant cell rich lesions, more common in this site.

Dosimetric evaluation using the diode measurements for total skin electron therapy technique

Objective： The purpose of this study was to present the dosimetric study and evaluation the dose delivered to the skin tumor by using diode detector with total skin electron therapy （TSET）. Methods： The total skin electron irradiation （TSEI） technique was used to treat ten patients with histological confirmed mycosis fungoides according to the Stanford staging system at the Radiotherapy Department, National Cancer Institute, Cairo University, Egypt. High dose rate electron beams with low electron energy 5 MeV from a Siemens linear accelerator were used for treatment. Diodes were calibrated at TSET distance 300 cm and field size （35 × 35） cm^2. Results： The result of diodes measurements showed the dose to flat surface of the body was within ：1：10 % from the prescribed dose. Special areas of the body such as the perineum ＆ eyelid showed large deviation up to 30% variation from the prescription dose. Conclusion： The diode results of this study will be used as a quality assurance check for all new patients treated with TSET and to compare it to the prescribed dose delivered to the patients. It is recommends to evaluate the diodes measurements for all patients throughout the full treatment cycle and to identify individually the boost dose areas.

Inhibition of human esophageal squamous cell carcinomas by targeted silencing of tumor enhancer genes: an overview

Esophageal cancer has been reported as the ninth most common malignancy and ranks as the sixth most frequent cause of death worldwide. Esophageal cancer treatment involves surgery, chemotherapy, radiation therapy, or combination therapy. Novel strategies are needed to boost the oncologic outcome. Recent advances in the molecular biology of esophageal cancer have documented the role of genetic alterations in tumorigenesis. Oncogenes serve a pivotal function in tumorigenesis. Targeted therapies are directed at the unique molecular signature of cancer cells for enhanced efficacy with low toxicity. RNA interference(RNAi) technology is a powerful tool for silencing endogenous or exogenous genes in mammalian cells. Related results have shown that targeting oncogenes with siRNAs, specifically the mRNA, effectively reduces tumor cell proliferation and induces apoptotic cell death. This article will briefly review studies on silencing tumor enhancer genes related to the induction of esophageal cancer.

CT引导下经皮穿刺化学消融术治疗淋巴结转移瘤的疗效分析

目的探讨引导下经皮穿刺化学消融术治疗单个与融合性淋巴结转移瘤的疗效、方法及安全性。方法回顾性分析46例淋巴结转移瘤患者的临床资料。46例患者按转移淋巴结情况分为、两组。组30例，为单个淋巴结，最大径为1．1～2．9m，平均（2．0±0．5）m；组16例，为融合淋巴结，最大径为2．7—4．9m，平均（3．8±0．6）m。患者均于引导下将5ml无水乙醇、2ml碘化油及10mg表阿霉素的混合液，经皮进行化学消融术治疗。扫描监测瘤内消融剂的覆盖率，记录两组患者的消融剂反流情况。分别于治疗后3、6、12个月复查，观察两组患者治疗后不同时间的局部反应及病变缓解情况，并记录相关并发症。计算两组的完全缓解率，采用标准化率比较率的差异。结果组30例患者，显示消融剂覆盖率均达100％，反流率达70％；组16例，消融剂覆盖率为70％-80％，反流率为40％。术后3、6及12个月复查示：组完全缓解分别为14、21、28例，部分缓解分别为16、9、2例；其中8例患者术前与术后6个月均行PE-扫描，显示消融区病变组织代谢明显降低。组无完全缓解，部分缓解分别为3、8、9例。两组数据采用标准化率，组标化完全缓解率（74．4％）高于组标化完全缓解率（0），差异有统计学意义（P=0．0001）。两组患者术后均无严重并发症发生，仅8例于注射过程中出现轻度疼痛，经穿刺针给予2．0～3．0m1利多卡因注射液后缓解，未见针道种植转移及感染等。结论引导下经皮穿刺化学消融术治疗可控制或减缓单个淋巴结转移瘤的进展，效果优于融合性病变。

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