Ⅰ期子宫内膜癌术后放疗分析

目的对Ⅰ期子宫内膜癌术后放疗的意义和放射并发症等进行探讨。方法１９８６年５月～１９９５年１２月收治Ⅰ期子宫内膜癌２０例，均经术后病理证实。１５例行子宫全切及双附件切除术，５例加盆腔淋巴结清扫。２０例均行术后放疗，大部分患者术后２～４周开始放疗，照射野包括全部盆腔淋巴结。全盆腔ＤＴ４０～５０Ｇｙ。全部患者得到随访。结果３，５，１０年生存率分别为１０／１０、８／９、３／４，局控率１００％（２０／２０）。５年远转率５％（１／２０）。２０例在放疗过程中均出现不同程度的急性放射并发症，６例有晚期放射并发症，其中２例较严重。结论术后放疗对提高局控率有利，但晚期损伤发病率相对较高。     

嗅神经母细胞瘤12例放射治疗探讨

目的探讨放射治疗在嗅神经母细胞瘤治疗中的地位和疗效。材料与方法１９８０年１２月～１９９６年６月间收治１２例嗅神经母细胞瘤（Ａ期１例、Ｂ期３例、Ｃ期８例），均经病理证实。９例单纯放疗，３例术后放疗。１例术后无残存予以Ｄ_Ｔ５０Ｇｙ，其余均在Ｄ_Ｔ６０Ｇｙ以上。颈部无淋巴结转移者未做预防照射。结果本组３，５，１０年生存率分别７／９．４／８，１／２。放疗结束时原发肿瘤近全消失，仅１例局部复发。其中Ｂ、Ｃ期病人６例原发灶放疗后出现区域淋巴结转移，７例出现远地转移再程放疗仍敏感。结论Ａ期放疗剂量在ＤＴ６０～６５Ｇｙ以上可很好地控制原发病灶；Ｂ、Ｃ期病人由于区域淋巴结及远地转移比例较高，有必要行颈淋巴结预防性照射及联合化疗的综合治疗。     

鼻腔嗅神经母细胞瘤治疗体会

目的 探讨鼻腔嗅神经母细胞瘤综合治疗价值 方法１９８０～１９９８年６月我科共收治６例鼻腔嗅神经母细胞瘤，均经病理学证实，男４例，女２例。年龄２１～６５岁，平均４９岁。所有病人首发症状均表现为持续性鼻塞或鼻衄，病程在２～１４个月。５例初诊时被误诊为鼻息肉等。根据Ｋａｄｉｓｈ分期：Ａ期１例，Ｂ期４例，Ｃ期１例。５例行手术加放疗综合治疗方式，１例术后７个月复发，再次手术后加放疗。结果 本组３例治疗后超过     

1446例鼻咽癌连续与分段放射治疗的比较

我院１９７７年至１９８０年共收治１４４６例鼻咽低分化鳞癌患者，行首程根治性放疗。其中连续放疗１０９３例，采用常规分次方式５０～７２Ｇｙ／５～７．５％周；分段放疗３５３例，即在常规治疗中间歇１０～４５天，平均２８．６天。５年生存率比较，连续组为３３．６％，分段组为２６．９％。其中Ⅲ、Ⅳ期病例连续组为３１％（２９０／９３３），分段间歇２１～３０天为２１．５％（３６／１０７），间歇３１～４５天为１８．８％（１７／９０），（Ｐ＜０．０５）。５年局校率Ⅲ、Ⅳ期病例连续组为２７．４％（２５６／９３３），分段组为１５．６％（４０／２５７），（Ｐ＜０．０１）。放疗后５年内远处转移率两组差别有极显著意义（Ｐ＜０．０１）。     

涎腺腺样囊性癌的放射治疗──附75例分析

１９７５年至１９８７年我院收治腺样囊性癌７５例。腮腺１２例，颌下腺１４例，舌下腺１例和小涎腺４８例。综合治疗５４例（７２％），单纯放疗１６例和单纯手术５例。５年随访率８７．９％，３、５和１０年生存率分别为７７．３％（５８／７５），６５．５％（３８／５８）和４５．２％（１４／３１）。单纯放疗、单纯手术和综合治疗５年生存率分别为３８．５％（５／１３），５０％（２／４）和７５．６％（３１／４１）（Ｐ＜０．０１），Ⅰ～Ⅳ期５年生存率分别为８１．３％（１３／１６）、７０％（１４／２０）、５３．３％（８／１５）和４２．９％（３／７）（Ｐ＜０．０５）。     

鼻腔嗅神经母细胞瘤治疗体会

目的　探讨鼻腔嗅神经母细胞瘤综合治疗价值　方法　１９８０ ～１９９８ 年６ 月我科共收治６ 例鼻腔嗅神经母细胞瘤,均经病理学证实,男４ 例,女２ 例。年龄２１ ～６５ 岁,平均４９ 岁。所有病人首发症状均表现为持续性鼻塞或鼻衄,病程在２～１４ 个月。５ 例初诊时被误诊为鼻息肉等。根据Ｋａｄｉｓｈ 分期：Ａ期１ 例,Ｂ期４例,Ｃ期１ 例。５ 例行手术加放疗综合治疗方式,１ 例术后７ 个月复发,再次手术后加放疗。结果　本组３ 例治疗后超过５ 年,其中２ 例分别无瘤生存５ 年和７ 年,１ 例生存６ 年后失访。另３ 例治疗后时间较短,２ 例分别无瘤生存５ 个月和１８ 个月,１ 例手术切除不干净,放疗后生存１ 年死于局部复发。所有病人治疗后未发现颈部淋巴结及其它部位转移。结论　作者认为手术加放疗是治疗鼻腔嗅神经母细胞瘤的有效治疗手段。     

55例Ⅲ期乳癌综合治疗疗效对比分析

对比分析Ⅲ期乳癌各种综合治疗方法的疗效。材料与方法１９８４年２月～１９９０年１０月，５５例Ⅲ期乳癌非随机分为：单纯手术（Ｓ）、手术＋化疗（Ｓ＋Ｃ）、手术＋放疗（Ｓ＋Ｒ）及手术＋放疗＋比疗（Ｓ＋Ｃ＋Ｒ）４组。手术为乳腺单纯切除术、乳癌根治术或改良根治术，术后放疗对胸壁及淋巴引流区照射ＤＴ４５～５５Ｇｙ／２２～３０欢／５～６周。术后化疗用ＣＭＦ或ＣＡＦ／ＣＥＦ方案４～６周期。结果全组５年生存率为４７．２％（２６／５５），Ｓ组１４．２％（１／７），Ｓ＋Ｃ组３３％（２／６）．Ｓ＋Ｒ组４７．３％（９／１９），Ｓ＋Ｒ＋ｃ组６０．８％，Ｓ组与其他几组相比差异有显著性意义（Ｐ＜０．００５）。３年复发率Ｓ组２８．５％（２／７），Ｓ＋Ｃ组６６．７％（４／６），Ｓ＋Ｒ组１５．８％（３／１９），Ｓ＋Ｒ＋Ｃ组１７．４％（４／２３），Ｓ＋Ｃ组与Ｓ＋Ｒ组或Ｓ＋Ｒ＋Ｃ组比差异有显著意义（Ｐ＜０．０５）。结论（１）Ⅲ期乳癌应作包括手术、放疗和化疗在内的综合治疗。（２）术后放疗对降低局部和区域淋巴结复发有重要作用，是其他治疗手段不能代替的。     

原发性食管小细胞未分化癌5例报告及文献综合分析

原发性食管小细胞未分化癌少见。本文对从国内文献收集的１３７例加上本院的５例共１４２例进行分析。发病年龄以５０～６０岁多见，男女之～为３．７９：ｌ，肿瘤长径范围为１．２～１５ｃｍ，平均５．６ｃｍ。病变发生于食管上１／３者１０例（７．５％）、中１／３８６例（６４．２％）、下１／３３８例（２８．３％）。髓质型５０例（４１％）、蕈伞型２６例（２１．３％）、溃疡型２４例（１９．７％）、腔内型１６例（１３．１％）、缩窄型６例（４．９％）。统计国内文献各该组发病率为０．７％～５．１％，本院组为０．１％。本病预后主，在可评价疗效的１３１例中，中位生存期和１年生存率：全组为７．６个月和２９％；单纯手术６．３个月和１８．４％；单纯放疗１１．８个月和３６．６％；放疗加化疗１２．３个月和５０％；手术加化疗１２．２个月和３９．３％。单纯化疗和手术加放疗中位生存期分别为５．５个月和５个月，无１年生存者。根据资料，作者认为使用放疗或根治性手术加用化疗可以提高本病的疗效。     

诱导化疗加放疗与单纯放疗不能手术的Ⅲ期非小细胞肺癌

目的评价诱导化疗加放射治疗不能手术的Ⅲ期非小细胞肺癌（ＮｏｎＳｍａｌＣｅｌＬｕｎｇＣａｎ－ｃｅｒ，ＮＳＣＬＣ）疗效。材料与方法１１１例不能手术的Ⅲ期ＮＳＣＬＣ病人被随机分为两组：５５例病人接受丝裂霉素８～１０ｍｇ／ｍ２，第１天；顺铂２０ｍｇ／ｍ２，第１～５天；长春花碱６ｍｇ／ｍ２，第６天（或长春酰胺３ｍｇ／ｍ２第１，８天）联合化疗（ＭＰＶ方案）；２～４疗程后给予放疗（化放组）。５６例病人接受单纯放疗（单放组）。两组放疗方式和剂量相同，常规分割放射，每次２Ｇｙ，每周５次。原发灶和淋巴结受累部位的总剂量为６０～６８Ｇｙ，淋巴引流区５０Ｇｙ。结果化放组总有效率为６３．６％，完全缓解（ＣＲ）１４．５％，中位生存期为１４个月；单放组总有效率为５５．４％，ＣＲ５．４％，中位生存期为１０个月。两组的总有效率无差别（Ｐ＞０．２５），但生存期有明显的差异（Ｐ＜０．０２５）。化疗的毒副反应主要是胃肠道反应和骨髓抑制。两组放疗副反应（急性和迟发性肺损伤）相似。结论诱导化疗加放射治疗不能手术的Ⅲ期ＮＳＣＬＣ，毒性可耐受，生存期优于单纯放疗。     

腔内近距离放射治疗直肠癌疗效初探

本文报道１９９１年９月至１９９２年９月采用高剂量率后装腔内近距离放疗结合体外放射治疗２０例直肠腺癌的近期疗效。完全缓解（ＣＲ）４例（４／２０，２０％），部分缓解（ＰＲ）７例（７／２０，３５％），微效（ＭＲ）６例（６／２０，３０％），稳定（Ｓ）２例（２／２０，１０％），进展（Ｐ）１例（１／２０，５％）．近期并发症轻微，远期反应及并发症尚待进一步随访观察。     

鼻腔嗅神经母细胞瘤11例临床分析

目的 回顾分析鼻腔嗅神经母细胞瘤的放疗疗效.方法 1974～1994年鼻腔嗅神经母细胞瘤11例,其中B期6例,C期5例.单纯放疗6例,术后放疗5例.3例术后无肿瘤肉眼残留者照射剂量D_T45Gy～55Gy/23～28次共4.5～5.5周.其余8例照射剂量D_T均在60Gy/30次共6周以上.3例颈淋巴结转移者照射剂量D_T60Gy～65Gy/30～33次共6～7周.结果 本组病例三、五年生存率分别为55%、36%,单纯放疗组分别为33%、17%,术后放疗组分别为80%、60%.P值0.2727,二组在统计学上无显著差异.全组病例中3例局部复发,2例血行转移.结论 B、C期患者根治性手术加术后放疗为局部控制的较好治疗方案.     

嗅神经母细胞瘤和嗅神经上皮瘤的临床特点和治疗评价

背景与目的：随着电镜和免疫组化诊断技术的提高，关于嗅神经母细胞瘤和嗅神经上皮瘤的报道逐渐增多。本研究回顾性分析嗅神经母细胞瘤和嗅神经上皮瘤的临床特点和治疗效果，探讨其治疗方法。方法：嗅神经母细胞瘤和嗅神经上皮瘤在临床上被认为是同一种疾病，故将经病理证实的19例嗅神经母细胞瘤和10例嗅神经上皮瘤共同分析。其中单纯放疗10例，术前放疗15例，术后放疗4例。根据Kadish分期标准，A期3例，B期8例，C期18例。生存分析采用Kaplan—meier法及Logrank检验：结果：患者表现为单侧鼻塞、单侧鼻衄或两者兼有者有26例，为89．66％。初次就诊时有颈淋巴结转移者5例，为17．24％。全组5年生存率、5年无瘤生存率分别为70．76％、66．48％：病理诊断为嗅神经母细胞瘤和嗅神经上皮瘤患者5年生存率及5年无瘤生存率比较差异无显著性。A／B期、C期5年生存率分别为100．00％、54．32％：有颈淋巴结转移者（N＋）和无颈淋巴结转移者（N0）4年无瘤生存率分别为60．00％、71．05％（P〈0．05）：结论：淋巴结转移是一个预后不良的因素，随着内镜手术的使用，放疗成为嗅神经母细胞瘤（嗅神经上皮瘤）的主要治疗方法。     

Nonplatinum-based chemotherapy with irinotecan plus docetaxel for advanced or metastatic olfactory neuroblastoma: a retrospective analysis of 12 cases

BACKGROUND: The efficacy and safety of chemotherapy with irinotecan plus docetaxel were retrospectively evaluated for olfactory neuroblastoma. METHODS: Twelve patients with histologically proven advanced or metastatic olfactory neuroblastoma were treated with chemotherapy with irinotecan plus docetaxel at the study institution between 2001 and 2005. Of these, 7 patients with locoregional disease and no prior radiotherapy received irinotecan plus docetaxel followed by definitive radiotherapy, 1 with photon radiotherapy and 6 with proton radiotherapy, whereas 3 patients with distant metastases and 2 with locoregional disease who had received prior radiotherapy received irinotecan plus docetaxel only. RESULTS: The most common toxicities of >or=grade 3 among the 12 patients receiving irinotecan plus docetaxel were leukopenia (33%), neutropenia (50%), febrile neutropenia (8%), and diarrhea (25%), all of which were manageable. Partial response was achieved in 3 patients, giving an overall response rate of 25%. The response rate was higher in patients aged <50 years (3 of 4 patients) compared with those aged >50 years (0 of 8 patients) (P = .018). With a median follow-up period of 22.2 months, the median progression-free survival and overall survival were 13.6 months and 36.6 months, respectively. Of the 7 patients with locoregional disease also receiving definitive radiotherapy, the 2-year survival rate was 100% and 6 patients were alive at the time of last follow-up. CONCLUSIONS: Chemotherapy for olfactory neuroblastoma with irinotecan plus docetaxel is safe and manageable. Patients aged <50 years may be sensitive to chemotherapy. Induction chemotherapy followed by definitive radiotherapy may represent a promising option for patients with locally advanced olfactory neuroblastoma.     

嗅神经母细胞瘤9例临床分析

目的 探讨嗅神经母细胞瘤的临床特点、诊断及治疗.方法 回顾性分析经病理证实的9例嗅神经母细胞瘤的临床资料.结果 按Kadish分期法,A期0例,B期7例,C期2例;9例中,2例行放疗+化疗,7例行手术+放疗,结果 显示含有手术的综合治疗方案疗效较好.结论 嗅神经母细胞瘤的发病率极低,因无特异性临床症状或体征而容易误诊,...     

嗅神经母细胞瘤的临床特点及治疗探讨

目的分析嗅神经母细胞瘤的临床特点,争取早期诊断、提高疗效.方法复习21例的全部病历、组织切片;按Kadish分期分成A、B、C 3期,分析其疗效.结果按Kadisk分期各种治疗总的5年生存率分别为100.0%、37.5%、10.0%.结论嗅神经母细胞瘤疗效与临床分期有关,治疗以放疗或手术加放疗最理想.     

Neoadjuvant etoposide, ifosfamide, and cisplatin for the treatment of olfactory neuroblastoma

BACKGROUND: The optimal chemotherapy regimen for the treatment of olfactory neuroblastoma has not been clearly defined. The purpose of the current study was to evaluate the efficacy of neoadjuvant chemotherapy with the combination of etoposide, ifosfamide, and cisplatin (VIP) for patients with olfactory neuroblastoma. METHODS: Eleven consecutive patients with newly diagnosed olfactory neuroblastoma were treated with etoposide (75 mg/m2), ifosfamide (1000 mg/m2), and cisplatin (20 mg/m2) all administered intravenously on Days 1-5. Cycles were repeated every 21 days. Patients were excluded from analysis if they had previously received surgery or radiotherapy. RESULTS: Nine patients achieved objective responses (objective response rate, 82%; 95% confidence interval, 52-95%), which included 2 complete responses and 7 partial responses. The major side effect was hematologic toxicity, with Grade 3/4 neutropenia observed after the receipt of 37% of all cycles and febrile neutropenia observed after the receipt of 2 cycles. All toxic events were reversible, and no chemotherapy-related deaths were documented. The median survival period was 18 months (range, 3-45 months). CONCLUSIONS: Neoadjuvant VIP chemotherapy was active in the treatment of olfactory neuroblastoma.     

鼻腔恶性肿瘤伴乳腺转移的临床表现及预后

目的 探讨鼻腔恶性肿瘤乳腺转移的临床表现及预后特征。方法 搜集1999年1月至2011年12月本院收治的846鼻腔恶性肿瘤患者临床资料,对发生乳腺转移患者的临床特征性表现、诊断方法、病理特点及预后进行分析。结果 共6例女性患者出现乳腺转移,发生率占0.7%。年龄13~37岁,中位数25岁。鼻腔原发灶病理分型分别为横纹肌肉瘤为3例、嗅神经母细胞瘤3例。腺转移多为多灶病变,可伴有其他部位的远处转移。6例患者中5例原发灶接受66~72 Gy分30~33次根治性放疗,1例鼻腔横纹肌肉瘤患者原发灶放疗14 Gy分7次时乳腺转移先行局部切除后给予原发灶44 Gy姑息放疗。6例患者中5例接受乳腺手术治疗,1例嗅神经母细胞瘤患者因乳腺转移前已发现多发肺转移及骨转移故接受了6周期环磷酰胺+阿霉素+长春新碱化疗。出现乳腺转移后的中位生存期为12.7个月。结论 鼻腔肿瘤的年轻女性患者易出现乳腺转移,超声检查可以为乳腺转移的诊断提供有用的信息,鼻腔肿瘤患者一旦出现乳腺及其他部位远处转移预后差。     

手术加放射治疗嗅神经母细胞瘤(附7例报告)

嗅神经母细胞瘤罕见,本文报道7例(Kadish分期体系:A期1例,B期及C期各3例)手术加术后放疗的结果,平均放疗剂量5942cGy.4例无病生存分别为9、18、19个月和17.5年.3例死亡,生存期分别为6、36和38个月.本文表明A、B期病例以手术加放疗的效果较好.     

Radiotherapy of olfactory neuroblastoma--report of 5 patients

Olfactory neuroblastoma is a rare tumor arising from the olfactory mucosal epithelium. 5 patients with this tumor were treated in our hospital from 1978 to 1982. The youngest patient was 3 years old and the eldest was 66. The clinical symptoms were nasal stuffiness, rhinorrhea, epistaxis and vascular polypoid mass in the nasal cavity. According to the staging system proposed by Kadish et al, the five patients in this series were 3 stage A and 2 stage C patients. Treatment consisted of radiotherapy, surgery or combination of radiotherapy and surgery. Our data indicate that the olfactory neuroblastoma is a radiosensitive tumor with the prognosis favorable in the stages A and B patients as treated by these three modalities. Two stage A patients are alive for more than 5 years. One of them was treated by radiotherapy alone, the other by combination of surgery and radiation. The third stage A patient as treated by radiotherapy alone has survived more than 3 years. One stage C patient, treated by combination of radiation and surgery, is still alive for more than 3 years. The other stage C patient, treated by radiotherapy alone, had survived for only 7 months after the treatment. The radiation dose varies with the extent of invasion. In stages A and B lesions, a dose of 4,500-5,500 rad in 5 weeks may be reasonable but in stage C, a dose of 6,000-6,500 rad in 7 weeks should be given. The authors agree to the prognostic equation proposed by Homzie et al. It may be possible to predict the tumor control or recurrence after a period of 3 years which gives an accuracy rate of 87%.