43例Ⅱb期宫颈癌术前放疗疗效分析

目的：探讨Ⅱb期宫颈癌经术前放疗的治疗效果。方法：1993年1月－2001年3月，43例Ⅱb期宫颈癌均接受术前放疗，放疗剂量DT36－40Gy，休息14d-20d后行宫颈癌根治术，结果：3年、5年生存率分别为77．6％，62．4％，3年内复发率为15．3％，结论：对部分Ⅱb期宫颈癌患，经术前放射治疗后，有手术适应症，行广泛性全子宫切除加盆腔淋巴结清扫术，可提高生存主,纲时避免单纯放射治疗引起的并发症。     

非根治术加放疗治疗86例Ⅱb期宫颈癌

目的：探讨非根治性手术加放疗配合治疗Ⅱb期宫颈癌的疗效及并发症。方法：回顾性分析了本科自1989年10月至1995年10月收治的Ⅱb期宫颈癌患86例，经放疗－非根治术－放疗的模式治疗。结果：5年生存率75．6％。近期放疗反应轻微，远期放疗并发症：放射性膀胱炎1例，发生率1．16％。放射性直肠炎5例，发生率5．81％。无膀胱阴道瘘及直肠阻道瘘发生。结论：非根治性手术加放疗治疗Ⅱb期宫颈癌临床上取得了较好的效果和较低的并发症，且手术难度小，便于普及，值得推广使用。     

早期宫颈癌术后辅助治疗疗效分析

目的:研究宫颈癌术后辅助治疗的选择与疗效.方法:回顾性分析159例宫颈癌根治术后辅助放疗加或不加化疗的患者治疗效果,选取130例同期行宫颈癌根治术的Ⅰb期及Ⅱa期未作术后辅助治疗患者作为对照组,进一步分析宫颈癌预后因素.159例患者中有87例放疗化疗综合治疗,72例单纯放疗.结果:289例患者总的5年生存率为89.3%,(单纯放疗组5年生存率88.9 % ,放疗化疗综合治疗5年生存率为 89.7%),对照组5年生存率72.9%.两者差异有显著性(P<0.05).结论:宫颈癌术后辅助治疗尤其对于盆腔淋巴结转移者有意义,临床和术后病理分期是术后辅助治疗的选择与疗效最主要的影响因素,不同病理类型及分级的宫颈癌术后辅助治疗可有不同的选择.     

中晚期宫颈癌放射、介入治疗的疗效分析

目的：通过不同治疗方法来观察中晚期宫颈癌的远期疗效，以选择最佳的治疗方案。方法：我院自1992年来采用放射治疗、放射加介入治疗宫颈癌90例。结果：Ⅲ期患者5年生存率放射加介入组明显高于放射组，Ⅳ期患者两组5年生存率无差异。结论：在本组中晚期宫颈癌治疗中，Ⅲ期患者介入治疗加放疗的疗效优于放射治疗。     

早期宫颈癌根治术后辅助治疗126例分析

目的：探讨早期宫颈癌术后辅助治疗方法的合理选择及临床价值。方法：回顾性分析了Ⅰb,Ⅱa期宫颈癌行根治术后加用放疗或化疗辅助治疗126例，其中单纯放疗64例，单纯化疗26例，放，化疗联合36例，对其治疗结果的预后因素进行分析。结果：126例总的五年生存率为73％（92／126），单纯放疗组，单纯化疗组，放，化疗联合组分别为76．6％（49／64），69．2％（18／26），69．4（25／36），临床分期及腹膜后淋巴结转移数目是最重要的预后因素。结论：早期宫颈癌根治术后辅助治疗的价值是有限的，但存在2个以上不良预后因素者，术后应加辅助治疗，同时应重视根治性手术彻底性。     

中晚期宫颈癌放射、介入治疗的疗效分析

目的：通过不同治疗方法来观察中晚期宫颈癌的远期疗效，以选择最佳的治疗方案，方法：我院自1992年来采用放射治疗，放射加介入治疗宫颈癌90例，结果：Ⅲ期患者5年生存率放射加介入组明显高于放射组，Ⅳ期患者两组5年生存率无差异，结论：在本组中晚期宫颈癌治疗中，Ⅲ期患者介入治疗加放疗的疗效优于放射治疗。     

放疗后宫颈癌根治术中输尿管梗阻的处理

目的　探讨经术前放疗后宫颈癌根治术中输尿管梗阻的处理。方法　 1978年 5月～ 1996年 6月 ,我院对171例中晚期宫颈癌 (行放疗、手术治疗 171例 )术前放疗后行宫颈癌根治术 ,术中发现输尿管梗阻 3 2例 ,占 18.7% ,双侧 9例、左侧 16例、右侧 7例。手术行子宫广泛切除术加盆腔淋巴结清扫术 ,同时对输尿管的梗阻进行手术处理 ,现对其进行回顾性分析总结。结果　手术 3 1例 ,放弃手术 1例 ,其中松解输尿管与周围组织粘连 2 7例 ,切除压迫输尿管转移淋巴结 2例 ,因癌性浸润输尿管而行部分输尿管切除 ,输尿管端端吻合术及输尿管膀胱吻合术各 1例。术后 2周输尿管引流通畅 ,肾功能明显好转 2 9例。经随访 ,2例患者 1年后因肾功能衰竭死亡 ,5年生存率为 48.3 9%。结论　中晚期宫颈癌放疗后出现输尿管梗阻 ,可考虑手术处理 ,可预防肾功能衰竭 ,能有效的提高患者的生存率     

非根治术或加放疗治疗Ⅰ,Ⅱ期宫颈癌

对全子宫加双侧附件切除或术前后补加放疗的１１８例宫颈癌（临床Ⅰ期７１例、Ⅱ期４７例）的疗效进行总结。结果，单纯手术组（２７例）５及１０年生存率为８机及６３％，补加放疗组（９１例）为７６％及６０％，组间比较Ｐ皆＞０．０５。与本院１７５例宫颈癌根治术相比，５及１０年生存率在Ⅰ期差别有显著性（Ｐ＜０．０１），在Ⅱ期差别无显著性（Ｐ＞０．０５）。放疗在术前或术后对生存无影响（Ｐ＞０．０５）。从本组有限的病例看，建议原位癌早期浸润应按０期癌对待只行全宫切除术，其它Ⅰ期癌应行根治术，Ⅱ期癌可行非根治手术并补加放疗。     

辅助化疗对行宫颈癌根治术患者作用的探讨

目的：探讨辅助化疗对行宫颈癌根治术患者改善预后的作用。方法：对1997年2月至1999年6月间在中山大学肿瘤医院妇科行宫颈癌根治术的123例患者进行回顾性对照分析，比较单纯手术组、手术＋化疗组、手术＋放疗组、手术＋放疗＋化疗组的3年生存情况。结果：单纯手术组与手术＋化疗组的中位生存时间分别为34^ 个月，37^ 个月，3年生存率分别为93．9％、95．5％（P均＞0．05）。手术＋放疗组与手术＋放疗＋化疗组的中位生存时间分别为24^ 个月、33^ 个月，3年生存率分别为93．2％、94．8％（P均＞0．05）。单纯手术组与手术＋化疗组的3年复发率分别为7．9％、6．2％（P＞0．05），手术＋放疗组与手术＋放疗＋化疗组的3年复发率分别为22．2％和23．1％（P＞0．05）。结论：目前的辅助化疗对行宫颈癌根治术患者改善预后的作用尚不确定，有待更多资料加以探讨。     

化疗和放疗联合治疗中晚期宫颈癌疗效分析

目的对比化疗配合放射治疗与单纯放疗治疗宫颈癌的疗效,探讨综合治疗在中晚期宫颈癌中的疗效及安全性。方法100例Ⅱ～Ⅲ中晚期宫颈癌患者分成两组,放疗同步化疗（A组）50例,在放疗同时给予PVB或PF方案化疗2～4周期,化疗第1天开始行放射治疗。单纯放疗组（B组）50例,两组放射治疗均用15MV—X线盆腔大野前后对穿体外照射,DT：45～50Gy;并加坶。IrHDR腔内后装照射,A点DT：20-25Gy。结果A组和B组近期有效率分别为94．0％和74．0％,两组的差异有显著性意义（P〈0．01）。A组和B组的3年生存率分别为76．0％和48．0％,差异有显著性意义（P〈0．05）。毒性反应方面,同步化放疗组高于单纯放疗组,尤以造血系统和消化道反应为主,但大部分能够耐受。结论中晚期宫颈癌患者PVB或PF方案同步放化疗可提高局部控制率和提高生存率。     

早期宫颈癌术后辅助治疗疗效分析

目的：研究宫颈癌术后辅助治疗的选择与疗效。方法：回顾性分析159例宫颈癌根治术后辅助放疗加或不加化疗的患者治疗效果,选取130例同期行宫颈癌根治术的Ⅰb期及Ⅱa期未作术后辅助治疗患者作为对照组,进一步分析宫颈癌预后因素。159例患者中有87例放疗化疗综合治疗,72例单纯放疗。结果：289例患者总的5年生存率为89.3%,（单纯放疗组5年生存率88.9%,放疗化疗综合治疗5年生存率为89.7%）,对照组5年生存率72.9%。两者差异有显著性（P〈0.05）。结论：宫颈癌术后辅助治疗尤其对于盆腔淋巴结转移者有意义,临床和术后病理分期是术后辅助治疗的选择与疗效最主要的影响因素,不同病理类型及分级的宫颈癌术后辅助治疗可有不同的选择。     

Radical prostatectomy for clinical stage T3a disease

BACKGROUND: Men with clinical stage T3a disease are at high risk and are often encouraged to undergo radiation therapy with concomitant hormonal therapy. The long-term outcomes among men treated with radical prostatectomy for clinical stage T3a disease were examined. METHODS: Among 3397 men treated by radical prostatectomy by 1 surgeon between 1987 and 2003, 62 (1.8%) men were identified who had clinical stage T3a disease. Among the 56 men not treated with neoadjuvant or adjuvant therapies before prostate-specific antigen (PSA) recurrence, the long-term outcomes of PSA-free survival, metastasis-free survival, and prostate cancer specific survival were examined. Median and mean follow-up after surgery were 10.3 and 13 years, respectively (range, 1-17). RESULTS: Ninety-one percent of men in this group had pathological T3 disease. PSA-free survival at 15 years after surgery was 49%. Metastasis-free survival and cause-specific survival at 15 years after surgery were 73% and 84%, respectively. Among men with a PSA recurrence, 46% received secondary therapy before metastasis. The only preoperative or pathological feature that predicted risk of prostate cancer death was lymph node metastasis (hazard ratio [HR]: 9.22, 95% confidence interval [CI]: 1.06-80.02, P = .044). Among the 28 men with a PSA recurrence, PSA doubling time (PSADT) data were available for 23, of which 11 (48%) has a PSADT >/=9 months. No patient with a PSADT >/=9 months died of prostate cancer. A PSADT <9 months was significantly associated with increased risk of prostate cancer death (log-rank, P = .004). CONCLUSIONS: In a select cohort of men with clinical stage T3a disease, radical prostatectomy alone provides long-term cancer control in about half of the men and results in a prostate cancer-specific survival of 84%. Among men with a PSA recurrence, PSADT at the time of recurrence is a useful determinant of risk of prostate cancer death.     

Primary radical radiotherapy for squamous cell carcinoma of the middle ear and external auditory cana--an historical series

AimsTo evaluate patients treated with radical radiotherapy alone for squamous cell carcinoma of the middle ear (MEC) and external auditory canal (EAC) in terms of freedom from local recurrence, cancer-specific survival and morbidity.Materials and methodsBetween 1965 and 1988, 123 patients were treated, 70 with MEC and 53 with EAC. The median age was 64 years (range 21–86) and 78% presented as late stage. The median dose was 55 Gy (range 39–55) in 16 once daily fractions (range 13–21).ResultsAt 5 and 10 years, respectively, freedom from local recurrence was 56 and 56%, disease-free survival was 45 and 43%, cancer-specific survival was 53 and 51%, and overall survival was 40 and 21%. Cancer-specific survival was significantly worse with late stage as opposed to early stage (P = 0.0026), as was local recurrence (P = 0.0088). No differences in survival and local control were seen according to site. Radionecrosis developed in 6% of patients.ConclusionsCombined treatment using radiotherapy and radical surgery is often favoured. This large series shows that radical radiotherapy achieves comparable results in terms of local control and cancer-specific survival. Our radiotherapy regimen is now 55 Gy in 20 daily fractions to reduce late morbidity. Radiotherapy alone remains a viable option, especially as morbidity can be minimised and target volume delineation optimised using computer planning in the future.     

Outcome of Palliative and Radical Radiotherapy in Patients with Oral Squamous Cell Carcinoma - a Retrospective Study

Background: The treatment selection for the oral squamous cell carcinoma remains controversial. Radiationtherapy or surgical excision of the lesion can be applied as the sole treatment or it can be used in combinationwith other treatment modalities. Radiotherapy is considered to be the safest of all the treatment modalities andcan be used in several situations for oral and oropharyngeal cancers. The aim of this study was to evaluate thesurvival outcome differences in patients treated with radical and palliative radiotherapy as the primary treatmentmodality. Materials and Methods: The study included a total of 47 patients with oral cancer reporting to ourhospital between years 2009 to 2010. The age group for the selected patients was more than 65 years, treatedwith radical and palliative radiotherapy with no prior surgical interventions. Patients were evaluated till Dec2013 for overall survival time. Results: Twenty nine patients were treated with radical radiotherapy as mainstay of treatment, out of which 21 died during the follow up time with median survival of 352 ± 281.7 days with8 patients alive. All the 16 patients were dead who received palliative radiotherapy with a median survival timeof 112 ± 144.0 days. Conclusions: This retrospective study showed improved overall survival time, loco regionalcontrol rates and reduced morbidity in patients treated with radical radiotherapy when compared to patientstreated with palliative radiotherapy.     

早期乳腺癌患者行乳腺癌根治术和保乳术后放疗的生存比较

目的 探讨乳腺癌根治术和保乳术后放疗对早期乳腺癌患者生存情况的影响.方法 选择早期乳腺癌379例,分为根治术组(341例)和保乳术后放疗组(38例).分别观察两组患者的Karnofsky评分和复发情况.结果 随访5年时保乳术后放疗组患者Karnofsky评分显著高于根治术组(P＜0.05);保乳术后放疗组患者1、3、5...     

宫颈癌手术百年发展历程

宫颈癌的手术治疗经历了100余年的发展过程.上世纪初前后,Wertheim氏创立的术式在全球范围内得到了广泛承认与推广,被认为经典手术.在手术的发展过程中,放射治疗一度延缓了根治手术的发展,随后又由于放射耐受等问题,手术再度受到广泛重视.半个世纪前,宫颈癌根治术以及阴式宫颈癌根治术传入我国,在全国各地逐渐开展起来,中国也为根治手术发展做出不少贡献.     

宫颈透明细胞癌50例临床病例分析

目的:探讨宫颈透明细胞癌的临床特点及相应的治疗方案.方法:2005年3月至2015年12月期间江西省妇幼保健院共收治宫颈透明细胞癌患者50例,回顾性分析患者的临床特点、生存率及治疗模式.结果:患者平均年龄51.6岁,20例为绝经患者.仅1例(20岁)患者未婚未育.患者主要表现为阴道异常流血或排液.早期患者(Ib1期-Ⅱa1期)5年生存率89%,中晚期患者(Ⅱb-Ⅲb期)5年生存率49%,两组5年生存率差异具有统计学意义(P<0.05). 13例死亡病例中,仅1例手术患者死亡,其余12例均为放化疗患者;放化疗组中有5例患者在放疗结束后6~8周接受全子宫+双附件切除术,无一例死亡.放化疗组内手术组较非手术组在生存率上有一定优势,但无统计学差异(P>0.05).结论:我院早期宫颈透明细胞癌患者手术治疗后具有较好的5年生存率,中晚期患者放化疗组内手术组较非手术组在生存率上有一定优势.由于该病发病率低、临床资料少,目前在治疗上仍存在经验不足,现多主张采用手术、放疗和化疗相结合的个体化综合治疗.     

扩大根治术用于中晚期胆囊癌的疗效及安全性分析

目的 探讨扩大根治术用于治疗中晚期胆囊癌的疗效及安全性.方法 将60例中晚期胆囊癌患者根据手术方式的不同分为标准根治术13例,扩大根治术20例,姑息性手术19例,剖腹探查术8例.观察不同术式的并发症.采用电话和门诊随访2年,比较不同术式患者的1年和2年生存率.结果 标准根治术、扩大根治术、姑息性手术和剖腹探查术的并发症发生率分别为7.7%、20.0%、10.5%和0.0%.Ⅲ期、Ⅳ期患者的的中位生存时间分别为6个月和5个月.Ⅲ期、Ⅳ期患者的1年和2年生存率分别为30.8%、15.4%,6.4%、4.3%.不同分期的胆囊癌患者生存率比较,差异无统计学意义(χ2=0.255,P=0.133).扩大根治术患者Ⅲ期和Ⅳ期的中位生存时间为12个月和10个月.在Ⅲ、Ⅳ期胆囊癌患者中,行不同术式患者生存率之间差异有统计学意义(χ2=10.036,P=0.018;χ2=15.829,P=0.001).结论 胆囊癌扩大根治术治疗中晚期胆囊癌可显著延长患者术后生存时间,但并发症发生率较高.临床上施行胆囊癌扩大根治术治疗中晚期胆囊癌时应严格遵循手术适应证.     

Radical reoperation for invasive cervical cancer found in simple hysterectomy

OBJECTIVE: To evaluate the patients with invasive cervical cancer found in simple hysterectomy and who were subjected to radical parametrectomy and upper vaginectomy with therapeutic lymphadenectomy. METHODS: Twenty-seven patients who underwent the radical parametrectomy and upper vaginectomy with therapeutic lymphadenectomy procedure from 1986 to 2004 were retrospectively reviewed. RESULTS: The mean age at the time of diagnosis was 49.85 (range 38-72). The histopathological diagnoses were SCC, adenocarcinoma, adenosquamous carcinoma, endometroid carcinoma, and anaplastic carcinoma in 70.4%, 11.4%, 7.4%, 7.4%, and 3.7% of patients, respectively. Operative complications occurred in only five patients (18.5%). Following radical surgery, residual disease was found in 10 patients (37.03%). The lymph node involvement rate was 22.2% (6 patients). The recurrence rate was 7.4% (2 of 27 patients). The overall disease-free survival rate was 88.67%. The overall survival rate was 88.89%; it was significantly lower in the presence of the following factors: anaplastic carcinoma, vaginal apex metastasis, and pelvic lymph node metastasis. CONCLUSION: This series suggests the excellent overall survival of patients that underwent radical surgery. We recommend the surgical treatment of such selected patients in experienced centers only with expert surgeons and primary adjuvant radiotherapy may be recommended in selected patients.     

National audit of the management and outcome of carcinoma of the cervix treated with radiotherapy in 1993

The aim of the study was to investigate the UK prevalence of late, severe side-effects associated with radical radiotherapy for cancer of the cervix and try to identify associated factors. All patients treated for cancer of the cervix with radical radiotherapy in 1993 were identified and retrospective case notes studied to determine mortality and severe complications occurring following treatment. Of the 55 radiotherapy departments in the UK that were treating gynaecological malignancy in 1993, 53 participated in the study. There were 1558 patients with carcinoma of the cervix receiving radical radiotherapy as part of their treatment regimen in 1993, whose patterns of treatment were assessed. The main outcome measures were the development of late severe complications as defined by the Franco-Italian Glossary and mortality. Of the patients receiving surgery and radiotherapy, 58.5% underwent Wertheim's procedure. The crude rate of late severe complications in all patients with cervical cancer treated with radical radiotherapy in 1993 was 6.1% (actuarial rate 8%) at 5 years, and only four of the 91 patients who developed complications died as a result of their morbidity. There was no significant correlation of stage, centre size, surgery or radiotherapeutic approach with late morbidity in univariate analysis. The overall survival at 5 years was 47% and was lower than that of the European data from FIGO's 1990–92 cohort, for all stages. Increasing FIGO stage was the only factor significantly associated with mortality. The absence of variables that were significantly associated with late complications may well be related to the relatively low event rate compared to the sample size. Differences in surgical treatment prior to radiotherapy and radiation technique may be confounding the comparison of outcomes. The relatively poor survival for locally advanced disease and the difficulty with which these data were collated indicates that national prospective data collection is urgently required to monitor performance and hence derive best practice.