74例原发性气管腺样囊性癌的临床分析

目的探讨原发性气管腺样囊性癌的临床特点。方法74例患者均经病理或细胞学证实。T分期中T18例(10.8%),T219例(25.7%),T323例(31.1%),T424例(32.4%)。纵隔淋巴结阳性8例(10.8%)。远处转移2例(2.7%)。62例(83.8%)接受手术治疗,27例手术完全切除,R1或R2切除35例。单纯手术24例,单纯放疗12例,综合治疗38例。结果复发或转移的患者共43例(58.1%),局部复发20例,远处转移17例,局部复发+远处转移6例。除2例外,所有远处转移患者均有肺转移。第一次复发或转移的中位时间为32月,第二次、第三次复发或转移的中位时间分别为12月和6月。所有患者中位生存时间55月,5年、10年总生存率分别为69.7%和35.9%。结论原发性气管腺样囊性癌治疗效果较好。病变长度、T分期以及包含手术的治疗可能是影响预后的因素。患者治疗后出现多次复发或转移,积极治疗仍能获得长期生存的机会。远处转移中肺转移最多见。

全脑放疗联合吉非替尼治疗EGFR突变阳性肺腺癌脑转移

【目的】评价全脑放疗（wBRT）联合吉非替尼治疗表皮生长因子受体（EGFR）突变阳性肺腺癌脑转移的疗效。【方法】回顾性分析70例EGFR突变阳性肺腺癌脑转移患者的临床资料，根据经济情况及意愿分为观察组40例和对照组30例。观察组行wBRT同时口服吉非替尼250mg，1次／天。对照组行WBRT同时口服替莫唑胺：150mg／m2，d1～5，28d重复，连续4个周期。分析比较两组患者近期疗效、无进展生存期、总生存期及治疗的毒副反应情况。【结果】治疗后第12周观察组和对照组的近期有效率分别为92．5％和70．0％，差异有统计学意义（X2=6．110，P=0．013）。观察组的中位无进展生存期和总生存期分别为16和27个月，对照组分别为7和13个月，差异均有统计学意义（均P=0．000）。两组的Ⅲ～Ⅳ级毒副反应：观察组痤疮样皮疹6例，对照组为0例，差异有统计学意义。两组乏力、恶心呕吐、腹泻、骨髓抑制等发生率差异均无统计学意义。【结论】WBRT联合吉非替尼治疗EGFR突变阳性肺腺癌脑转移患者的近、远期疗效显著，副反应可以耐受。

SiewertⅡ、Ⅲ型食管胃结合部腺癌术前受累野照射同期化疗可行性分析

目的 探讨局部进展期SiewertⅡ、Ⅲ型食管胃结合部腺癌（AEG）术前受累野照射同期化疗的可行性。方法 前瞻性纳入局部进展期SiewertⅡ、Ⅲ型AEG患者45例,术前行XELOX方案化疗2个周期,同期受累野IMRT 45 Gy分25次,5 次/周,6-8周后手术切除。CT模拟定位前胃体水充盈800~1000 ml,以厚度〉5 mm管壁勾画GTV-t,上沿食管方向外扩2.0 cm,下沿胃体方向外扩1.5~2.0 cm,轴向外扩0.8 cm为CTV-t;GTV-nd依据CT/MRI等影像学检查结果进行勾画;CTV-nd仅包括GTV-nd和淋巴结转移受累区域;外扩0.8~1.0 cm定义为PTV。通过分析术后病理结果及放疗不良反应探讨靶区勾画方式的可行性。结果 45例患者均完成术前同期放化疗和手术治疗,完成同期2个周期化疗者39例,1个周期者6例。R0切除率为96%,pCR率为22%。肿瘤退缩分级0、1、2、3级分别10、17、15、3例。淋巴结转移率为38%（17/45）,淋巴结转移度为4.33%（46/1062）。术后病理T、N降期24、26例,术后T3—T4期所占比例较疗前降低51%,术后淋巴结阳性者所占比例较疗前降低42%（P=0.000、0.000）。放射性食管炎/胃炎发生率为44%,其中1、2、3级发生率分别为18%、22%、4%,急性放射性肺炎发生率为7%,均为1、2级。围手术期治疗相关病死1例。结论 SiewertⅡ、Ⅲ型局部进展期AEG患者术前XELOX方案化疗2个周期联合45 Gy同期放疗可以实现较高的pCR率,可有效降低淋巴结转移率,实现降期并增加根治性手术的R0切除率。该方案具有急性放射性不良反应发生率低、患者耐受性好、围手术期治疗相关病死情况在可接受范围内等优势。行淋巴结转移受累区域照射的靶区勾画方式具备可行性。

Siewert Ⅱ和Ⅲ型食管胃结合部腺癌术前受累野照射同期放化疗生存分析

目的 探讨局部进展期Siewert Ⅱ、Ⅲ型食管胃结合部腺癌（AEG）术前受累野照射同期新辅助放化疗的效果、急性不良反应及生存分析。方法 前瞻性纳入2011年-2015年4月河北医科大学第四医院收治的Siewert Ⅱ、Ⅲ型局部进展期AEG患者45例,术前受累野照射45 Gy分25次,5 次/周,同期行XELOX方案化疗2个周期,6周-8周后进行手术切除,术后化疗6个周期。观察术前新辅助放化疗完成情况、术后病理情况、降期及不良反应,应用Kaplan-Meier法进行生存分析。结果 45例患者均完成术前同期放化疗和手术治疗,完成同期2个周期放化疗39例,1个周期6例。手术中位间隔时间为6周,R0切除率为96%（43/45）,pCR率为22%（10/45）,TNM降期率为68.9%。急性放射性食管炎/胃炎的发生率为44%（20/45）,放射性肺炎的发生率为7%（3/45）。1、2、3级白细胞、血小板和中性粒细胞计数减低的发生率分别为78%、47%和44%。非血液学不良反应主要为消化道反应,其中恶心、呕吐、食欲不振的发生率分别为62%、24%、71%,未见4、5级血液学及非血液学不良反应。中位随访时间30个月,病死13例（肿瘤死亡11例,肺部感染死亡1例,围手术期治疗相关死亡1例）,术后1、2、3年PFS率分别为90%、70%、67%,OS率分别为95%、80%、75%,局部控制率分别为95%、84%、84%,远处转移率分别为7%、25%、25%。结论 Siewert Ⅱ、Ⅲ型局部进展期AEG术前受累野照射同期放化疗可以实现较高的PFS率、OS率和局部控制率,患者耐受性良好。新辅助放化疗联合手术治疗后需辅助化疗4个周期。

Treatment of Unresectable Carcinoma of Pancreas with ^(125)I Implantation and ^(125)I Plus Gemcitabine

Objective: To study the role of 125 I and 125 I plus gemcitabine (GEM) in treatment of unresectable carcinoma of pancreas. Methods: From April 2000 to April 2003, 38 untreated patients with locally advanced pancreatic cancer (LAPC) were collected and randomized into two groups: Arm A 125 I (18 patients) and Arm B 125 I+GEM (20 patients). Eligibility criteria were: cytologically and pathologically proven pancreatic carcinoma, Karnofsky performance status (kps) 60 80, age 18 75 years, adequate hematological, renal and liver function, and controllable pain. Arm A patients were treated with 125 I implants. Arm B patients started chemotherapy within 10 14 d post operatively following the implant procedure. Chemotherapy doses were as follows: GEM 1 000 mg/m 2 weekly × 3 followed by 1 week of rest for 3 cycles. In addition, all patients underwent laparotomy and surgical staging. The surgical procedures performed were biopsy, gastric bypass and biliary bypass. The total activity and number of seeds used were as recommended by Anderson. The mean activity, minimal peripheral dose (MPD), and volume of implants were 20 mCi, 14 000 cGy, and 53 cm 3, respectively. Results: Overall response rate (CR+PR) in Arm A was 37.6% and in Arm B it was 44.5% ( P >0.05). PR median duration in Arm A was 6.7 months and in Arm B it was 4.8 months ( P <0.05). Clinical benefit response was experienced by 11.7 % of Arm A compared with 42.1% of Arm B ( P <0.05). The incidences of hematological toxicity (such as neutropenia) between Arm A and Arm B were 5.8% and 21.1%, respectively ( P >0.05). The survival rates of 12 and 24 month were 32.5%, 16.3% for Arm A and 61%, 38.7% for Arm B ( P =0.04). The rate of complication of Arm A was lower than that of Arm B without statistical significance. Conclusion: To some extent, 125 I or 125 I plus GEM is able to lead to a moderate objective response for LAPC with obstructive jaundice on the base of biliary bypass or/and gastric bypass, but 125 I plus GEM is more effective than 125 I in improvement of the quality of life and survival rate in patients with LAPC.

颌下腺腺样囊性癌伴淋巴结转移及右股骨干单发转移一例报告及文献复习

腺样囊性癌是一种源于涎腺的罕见头颈部恶性肿瘤,病程进展缓慢,较少发生淋巴结转移,但局部浸润强,容易沿神经和血管侵袭,复发率和远处转移率都较高。远处转移以肺脏多见,骨转移较少,发生股骨干单发转移的病例更为罕见。本文将结合1例经我院综合治疗的颌下腺腺样囊性癌伴右侧股骨干上段单发转移患者的治疗经过及近期随访结果同时结合文献进行报道。

A study of transarterial infusion chemotherapy of gemcitabine plus three dimensional conformal radiotherapy for local advanced pancreatic cancer

Objective: To evaluate the clinical effect of transarterial infusion chemotherapy of gemcitabine plus three dimen- sional conformal radiotherapy on patients with local advanced pancreatic cancer. Methods: Fifty-one patients with local ad- vanced pancreatic cancer from June 2002 to February 2004 were enrolled, twenty-four patients of combined group were treat- ed with transarterial infusion chemotherapy of gemcitabine plus three dimensional conformal radiotherapy, while twenty-seven patients of control group were treated only with transarterial infusion chemotherapy of gemcitabine. Results: There were significant statistical differences between two groups in clinical benefit response (91.7% versus 74.1%, P < 0.01) and overall remission rate (70.8% versus 33.3%, P < 0.01). The 6-month survival rate, 12-month survival rate and 24-month survival rate of combined group were 83.3%, 62.5% and 37.5% respectively, while that of control group were 55.6%, 33.3% and 11.1% respectively. This showed significant difference between the two groups. Conclusion: Transarterial infusion chemotherapy of gemcitabine plus three dimensional conformal radiotherapy may be better than single transarterial infusion chemotherapy of gemcitabine in improving survival rates and elongating survival time of patients with local advanced pancreatic cancer.

腺样囊性癌肺转移一例报告及文献复习

目的分析腺样囊性癌伴肺转移的临床特点和治疗情况,提高对腺样囊性癌的认识。方法通过1例腺样囊性癌肺转移病例,结合文献对治疗方案选择、放疗剂量和肺转移的治疗3个方面进行了分析和综述。结果本例腺样囊性癌患者采用了手术联合放疗方案,术后放疗予瘤床区域同步加量达75Gy,随访过程中出现双肺多发转移灶。采取立体定向放疗后部分缓解,未出现严重的放疗相关并发症。结论腺样囊性癌在治疗上应评估患者病情,可行手术的应行根治性切除术联合术后放疗,通常放疗剂量需≥60Gy,切缘阳性者可适当增加放疗剂量。易发生肺转移,如不适合手术或患者不愿意行手术治疗的可采用立体定向放疗。

Sublethal Irradiation Promotes Migration and Invasiveness of Prostate Cancer PC-3 Cells:Implications for Radiotherapy of Human Prostate Cancer

OBJECTIVE To study the changes in the matrix metalloproteinases-2 and 9 （MMP2, MMP9） induced by ^60Co γ-ray external irradiation of human prostate cancer PC-3 cells. METHODS Human prostate cancer PC-3 cells were irradiated with different doses of ^60Co γ-rays. Cell migration and invasiveness were evaluated and the expression of MMP2, and MMP9 was investigated by RT-PCR, Western blotting and flow cytometry（FCM）. RESULTS Irradiation enchances invasive protential at the doses of 1,3 and 5 Gy,whereas it significantly inhibits cell migration. CONCLUSION The different doses of ^60Co γ-ray external irradiation for prostate cancer may have different effects through the changes of MMP2, and MMP9 expression.

Presentation of Axillary Metastases from Occult Breast Carcinoma

Axillary presentation from occult breast cancer is uncommon and continues to be a diagnostic and therapeutic challenge to physicians. Once the diagnosis of adenocarcinoma metastatic to an axillary lymph node has been confi rmed, a preoperative workup should be done. The current experience is based on several relatively small retrospective reviews and case reports. It is diffi cult to determine the best management of occult breast cancer. However, treatment of axillary lymph node dissection is recommended for local control and complete staging information. Treatment of breast should be a choice between breast conservation with whole-breast radiotherapy and mastectomy. Adjuvant systemic treatment should be offered.

Breast-conserving surgery and combined therapy for women breast cancer: a report of 216 cases

Objective： To explore the therapeutic effect and associated techniques of breast-conserving therapy on patients with clinical stage Ⅰ and stage Ⅱ breast cancer. Methods： 216 female patients with breast cancer underwent breast-conserving therapy from December 1993 to October 2004. Their data were analyzed retrospectively. The breast-conserving therapy consisted of lumpectomy or quadrant removal of the breast, postoperative radiotherapy, chemotherapy and endocrine therapy. Of them, 209 patients underwent axillary lymph node dissection. Results： There were no operative complications. 216 patients were followed-up 3 to 147 months, the medial follow-up time was 78 months. The local recurrence rate was 1.85%. Two patients died and one of them was not related with breast cancer. Presence or absence of fibrosis, shape of breast, asymmetry, pigmentation and handle were taken into consideration for cosmetic evaluation by the patients and experienced breast surgeon. Breasts were scored cosmetically as excellent and good in 199 patients, the rate of satisfactory was 92.13%. Conclusion： Breast-conserving therapy for early breast cancer is e safe end effective therapy. It has less trauma end less complications and can also raise the quality of life in the patients. But we must obey the strict indications and reasonable techniques.