95例伴气管食管沟淋巴结转移食管癌三维放疗±化疗疗效分析

目的 探讨食管癌气管食管沟淋巴结(TGLN)转移患者3DCRT±化疗疗效。方法 对2003—2010年间符合入组条件的95例有TGLN转移的食管癌患者治疗情况进行回顾分析,分析疗效、预后影响因素及治疗失败模式等。 95例放疗 54~68 Gy分27~34次5~7周完成, 38例加“顺铂”为基础方案化疗,其中同期放化疗14例、序贯放化疗24例。Kaplan Meier 法计算生存率, Cox 模型多因素预后分析。结果 随访率100%。治疗结束后患者食管病变总有效率为94%;转移淋巴结病变治疗后有效率为100%。1、2、 3年OS分别为53%、32%、24%,中位生存时间13个月。多因素分析结果显示患者治疗前有无胸背部疼痛(P=0.041)、病变造影长度(P=0.002)及食管病变近期疗效(P=0.000)为预后影响因素。全组患者出现单纯食管复发18例,单纯淋巴结转移或复发 4例,食管复发伴淋巴结转移或复发 5例,单纯远处转移 28例,食管复发伴远处转移4例,远处转移伴淋巴结转移或复发3例,食管复发合并淋巴结转移或复发并伴远处转移 2例。结论 食管癌伴TGLN转移患者接受3DCRT ±化疗较为安全,但疗效有待进一步提高。影响食管癌伴TGLN转移患者的主要预后因素与食管病变相关。     

乳腺癌保乳手术治疗的临床研究

目的:总结保乳手术治疗早期乳腺癌临床经验及观察近期疗效.方法: 2000年1月至2006年12月采用肿块局部广泛切除加腋淋巴结清扫或象限切除加腋淋巴结清扫治疗临床单发的、肿瘤直径小于3.0cm、无区域淋巴结转移的女性乳腺癌患者51例,手术切缘距瘤缘2.0cm～3.0cm,术后行辅助放疗、化疗及内分泌治疗.结果: 全组随访3～84个月,局部无复发或远处转移.结论: 早期乳腺癌病人接受保乳手术治疗可以取得满意的临床和美容效果.     

乳腺癌保乳手术治疗的临床研究

目的：总结保乳手术治疗早期乳腺癌临床经验及观察近期疗效。方法：2000年1月至2006年12月采用肿块局部广泛切除加腋淋巴结清扫或象限切除加腋淋巴结清扫治疗临床单发的、肿瘤直径小于3．0cm、无区域淋巴结转移的女性乳腺癌患者51例，手术切缘距瘤缘2．0cm～3．0cm，术后行辅助放疗、化疗及内分泌治疗。结果：全组随访3～84个月，局部无复发或远处转移。结论：早期乳腺癌病人接受保乳手术治疗可以取得满意的临床和美容效果。     

胃贲门癌两种根治术的疗效比较

本文总结我院自1954年12月至1981年底用根治术治疗胃贲门癌440例的经验。本组的区域淋巴结转移率为70％。全组病人的5年生存率为18.5％,10年生存率为10.7％。 Ⅰ期贲门癌根治术Ⅰ式与根治术Ⅱ式的疗效相似。Ⅱ期贲门癌无论区域淋巴结有否转移,Ⅱ式的疗效皆优于Ⅰ式,但统计学处理并无显著差别。Ⅲ期淋巴结阴性患者,Ⅱ式疗效虽优于Ⅰ式,但无统计学意义;惟淋巴结阳性患者,Ⅱ式疗效确实优于Ⅰ式(P<0.05) 胃贲门癌的发病率约占胃癌的20％,其症状同于食管下端癌,某些早期贲门癌在临床上易与食管下端癌混淆,只能在手术标本上大致判断其原发部位。目前,手术治疗仍是治疗胃癌的治愈性手段,而化疗仅能收到一定的姑息效果。今将我院用两种根治术治疗贲门癌的结果报道于下。     

原发性食管单纯腺癌27例临床分析及文献复习

本文报告２７例经组织学证实的原发性食管单纯腺癌，其１、３、５年生存率分别为８１．５％、５１．９％和２２．２％，治疗后５年内约有７６．９％的病人死于肿瘤局部未控、复发或远处转移，影响原发性食管单纯腺癌预后的主要因素为其临床分期、肿瘤外侵程度和有无淋巴结转移等。根据本文结果，笔者认为食管腺癌的生物学特性与肺腺癌基本相似；其发生与Ｂｓｒｒｅｔｔ＇ｓ食管可能无明显关系；对于较早期患者应采取积极的根治性手术，手术切除后如何配合有效的放疗和化疗仍是提高原发性食管单纯腺癌疗效的方向。     

局部晚期食管下段癌术前动脉灌注化疗临床疗效观察

目的:探讨局部晚期食管下段癌术前动脉灌注化疗的临床疗效.方法:64例局部晚期食管下段癌患者随机分为两组:术前灌注化疗组及直接手术组.前者术前行选择性动脉灌注化疗:表柔比星60-80mg,顺铂40-60mg,5-FU 750-1000mg.化疗后2周左右接受手术治疗.观察动脉灌注化疗不良反应、组织学疗效,并比较两组手术切除率及手术并发症.结果:动脉灌注化疗不良反应主要表现为胃肠道反应和骨髓抑制,均为Ⅱ度以下.灌注化疗组手术切除率为100％,R0切除率为87.5％ (28/32),均高于直接手术组(P＜0.05),后者手术切除率为78.1％ (25/32),R0切除率为62.5％(20/32).术后并发症两组之间无统计学差异(P＞0.05).术前灌注化疗组术后病理分期较术前降低,其中Ⅱ期病例明显增多.结论:局部晚期食管下段癌术前选择性动脉灌注化疗可降低临床分期,提高手术切除率.     

嗅神经母细胞瘤综合治疗疗效及失败模式分析

目的 分析嗅神经母细胞瘤单中心的治疗疗效及失败模式。方法 回顾性分析本院1979—2014年间初诊112例无远处转移嗅神经母细胞瘤病例,改良Kadish分期A期1例、B期23例、C期60例、D期28例。手术+术后放疗±化疗者51例,放疗±化疗者46例,术前放疗+手术±化疗者11例,手术±化疗者3例,单纯化疗者1例。Kaplan-Meier法计算生存率。结果 全组5年样本数44例, 5年OS和DFS分别为66%和55%,术前放疗+手术±化疗者分别为91%和82%,手术+术后放疗±化疗者分别为80%和66%,放疗±化疗者分别为46%和37%。3例单纯手术均出现复发,1例姑息化疗者生存时间为6个月。全组共47例治疗失败,失败率为42%,以远处转移为首次失败方式者占总失败的53%、局部区域复发占36%、同时存在局部区域复发及远处转移者为11%。结论 嗅神经母细胞瘤治疗仍推荐放疗+手术综合治疗方案。综合治疗模式下嗅神经母细胞瘤局部区域控制率及疗效尚可,主要失败方式为远处转移。     

乳腺癌术后辅助治疗疗效分析

 目的　探索乳腺癌根治术后患者病期、淋巴结情况及治疗方法对生存率的影响。方法对比分析我科收治的乳腺癌术后Ⅱ期110例和Ⅲ期90例,采用术后放疗、术后化疗及术后放疗加化疗进行治疗。结果　Ⅱ期和Ⅲ期乳腺癌患者术后放疗、术后化疗+放疗局部复发率均低于术后化疗(P＜0.05);Ⅲ期患者远处转移率术后放疗高于术后化疗或术后放疗+化疗(P＜0.05);Ⅱ期乳腺癌腋窝淋巴结转移数≥4个,生存率下降;Ⅲ期乳腺癌患者随着N的升级,五年生存率逐渐降低。结论　乳腺癌术后放疗可以减少局部复发率;Ⅲ期乳腺癌术后化疗可降低远处转移率;淋巴结转移数影响5年生存率。     

B超对贲门癌分期的评价(附81例报告)

目的　对贲门癌术前正确分期 ,帮助选择手术入路方法 ,以提高贲门癌切除率。方法　应用B超对 81例贲门癌进行诊断、分期 ,与术后病理分期对照研究。结果　B超对贲门癌原发肿瘤的诊断率为 93 8% ,淋巴结显示率为 6 6 1% ,远处转移显示率为90 0 %。结论　B超对贲门癌的浸润深度、淋巴结转移情况及与周围组织关系的诊断明确 ,可作为贲门癌分期的初步评价 ,补充胃镜及吞钡的不足 ,对手术提供正确的入路方法。     

39例早期贲门癌外科治疗分析

目的 探讨早期贲门癌外科治疗的远期疗效.方法 回顾性分析39例早期贲门癌的术前内窥镜检查、病理类型、癌组织浸润深度、淋巴结转移、手术方式及预后.结果 全组39例患者的1、3、5 a生存率分别为100.0%、94.8%、89.7%;5 a内死亡4例,均死于远处脏器转移.结论 影响贲门癌长期生存的因素除了疾病本身的因素外,可能还与患者的身体内环境、心理和社会因素有关.     

食管癌综合治疗与单一手术治疗的比较

目的评价Ⅱ、Ⅲ期食管癌术前化疗的价值。方法对50例Ⅱ、Ⅲ期食管癌患者进行以顺铂为主的联合化疗,并与同期内50例单纯手术患者进行比较分析,进一步探讨提高Ⅱ、Ⅲ期食管癌患者的远期疗效。结果单纯手术组5年生存率为32.0%,术前化疗组5年生存率为46.0%,两组差异有显著性(P＜0.05)。结论术前化疗复发率及转移率低,术前化疗组5年生存率高于单纯手术组。     

Neoadjuvant chemotherapy for resectable esophageal carcinoma: a meta-analysis of randomized clinical trials

Neoadjuvant chemotherapy for resectable esophageal carcinoma has been a focus of study, but no agreement has been reached on clinical randomized controlled trials and relevant systematic evaluation. The purpose of this study was to perform a meta-analysis on published randomized controlled trials (RCTs) that compared neoadjuvant chemotherapy and surgery with surgery alone for resectable esophageal carcinoma. Medline and manual searches was conducted in PubMed, ASCO (American Society of Clinical Oncology) meeting summary, Embase, the Cochrane Library (up to October 2010), Chinese Biomedical Literature Database, China National Knowledge Infrastructure, VIP Database, Wanfang Database. The selection contents were to identify all published and unpublished RCTs that compared neoadjuvant chemotherapy and surgery with surgery alone for resectable esophageal carcinoma. Sixteen RCTs which included 2,594 patients were selected. The risk ratio (RR) (95% confidence interval [CI]; P value), expressed as neoadjuvant chemotherapy and surgery versus surgery alone (treatment versus control), was 1.02 (0.95, 1.10; P=0.54) for 1-year survival, 1.29 (1.13, 1.47; P=0.0001) for 3-year survival, 1.31 (1.13, 1.51; P=0.0003) for 5-year survival, 1.00 (0.95, 1.04; P= 0.85) for rate of resection and 0.89 (0.64, 1.23; P=0.48) for operative mortality. The results showed that neoadjuvant chemotherapy for resectable esophageal carcinoma can raise the overall survival rate of patients with esophageal carcinoma, but it does not affect treatment-related mortality.     

Only pathologic complete response to neoadjuvant chemotherapy improves significantly the long term survival of patients with resectable esophageal squamous cell carcinoma: final report of a randomized, controlled trial of preoperative chemotherapy versus surgery alone

BACKGROUND: Surgery is the standard treatment for patients with resectable esophageal carcinoma, but the long term prognosis of these patients is unsatisfactory. Some randomized trials of preoperative chemotherapy suggest that the prognosis of patients who respond may be improved. METHODS: This randomized, controlled trial compared patients with clinically resectable esophageal epidermoid carcinoma who underwent surgery alone (Arm A) with those who received preoperative chemotherapy (Arm B). Overall survival and the prognostic impact of major response to chemotherapy were analyzed. Forty-eight patients were enrolled in each arm. Chemotherapy consisted of two or three cycles of cisplatin (100 mg/m2 on Day 1) and 5- fluorouracil (1000 mg/m2 per day continuous infusion on Days 1-5). In both study arms, transthoracic esophagectomy plus two-field lymphadenectomy was performed. The two groups were comparable in terms of patient characteristics. RESULTS: Forty-seven patients were evaluable in each arm. The curative resection rate was 74.4% (35 of 47 patients) in Arm A and 78.7% (37 of 47 patients) in Arm B. Treatment-related mortality was 4.2% in both arms. The response rate to preoperative chemotherapy was 40% (19 of 47 patients), including 6 patients (12.8%) who achieved a pathologic complete responses. Overall survival was not improved significantly. The 19 patients in Arm B who responded to chemotherapy and underwent curative resection had significantly better 3-year and 5-year survival rates (74% and 60%, respectively) compared with both nonresponders (24% and 12%, respectively; P = 0.0002) and patients in Arm A who underwent complete resection (46% and 26%, respectively; P = 0.01): Patients who achieved a pathologic complete response (P = 0.01), but not those who achieved a partial response (P = 0.2), had significantly improved survival. CONCLUSIONS: Patients with resectable esophageal carcinoma who underwent preoperative chemotherapy and obtained a pathologic complete response had a significantly improved long term survival. Major efforts should be undertaken to identify patients before neoadjuvant treatments who are likely to respond.     

食管癌化疗的演变及其在综合治疗中的作用

本文评述食管癌化疗的前景与困难.全身化学治疗有可能提高食管癌患者缓解率,延长生存期和改善生活质量.联合化疗治疗食管癌有明显优越性.顺铂 氟尿嘧啶(加或不加醛氢叶酸)认为是最佳联合化疗药物,对食管鳞癌的有效率为42%～66%,对食管腺癌的有效率为27%～48%.评价较新的化疗药物,包括紫杉醇类和喜树碱类(如伊利替康)可有助于选择更为有效和较好耐受的全身治疗方案.由于单用手术或单用放疗的患者预后较差,推动食管癌的综合治疗.目前临床试验有术前(新辅助)化疗,术前同时联合化-放疗,或对局部区域病变单用化-放疗,以及对有高复发危险的患者行术后(辅助)化疗,将有助于为食管癌患者提供最佳的治疗方案.     

Preoperative chemotherapy for esophageal carcinoma with intramural metastasis

BACKGROUND AND OBJECTIVES: The prognosis for patients with intramural metastasis (IMM) of esophageal cancer is poor. We examined the role of preoperative chemotherapy in the management of patients with this disease. METHODS: Fifteen patients with IMM of esophageal carcinoma received preoperative chemotherapy cisplatin on day 1 and 5-fluorouracil on days 1 to 5. This regimen was repeated after a 3-week interval, except in patients with progressive disease or severe toxicity who received only one cycle of chemotherapy. Patients underwent surgery around 3 weeks after completion of chemotherapy. Clinical response was evaluated and survival was compared with that of patients who did not receive preoperative chemotherapy. RESULTS: Toxicity was manageable except in one patient who experienced severe neurological adverse effect. The clinical response rate of the IMM was 66.7% (10/15) and the complete response rate was 6.7% (1/15); for the primary lesion, response rates were 86. 7% and 6.7%, respectively. All 15 patients underwent surgery. Seven of the 15 patients (46.7%) experienced non-fatal operative complications. The 5-year survival rate after surgery was 20%. CONCLUSIONS: Preoperative chemotherapy with cisplatin and 5-fluorouracil is feasible in patients with IMM of esophageal carcinoma. This regimen, however, does not improve survival and more effective treatment strategies are required.     

Management of Cervical Esophageal Carcinoma

Surgery and radiotherapy yield equivalent results for patients with carcinoma of the cervical esophagus, with long-term survival of less than one in four patients. The advantages of radiotherapy are lower rates of acute morbidity and mortality compared with surgery, and potential for larynx preservation. The advantage of surgery is that the transposed stomach may function better over the long term than an irradiated esophagus, which tends to become stenotic over time. Patients with resectable cancers who are in good general medical condition may be treated with preoperative irradiation and surgery in an effort to improve the likelihood of local control and obtain a good functional result. Patients with relatively early lesions who are not good surgical candidates can be treated with high-dose radiation therapy. Patients with very advanced local disease and those with distant metastases are treated with palliative irradiation. Concurrent chemotherapy and radiotherapy has been shown to be superior to radiotherapy alone in managing esophageal cancer. Although relatively few patients with cervical esophageal cancer have been treated with this combination, some studies suggest it may be curative for patients with early lesions of the cervical esophagus, without the need for esophagectomy. Adjuvant chemotherapy is usually not used outside of a study setting.     

50例原发性食管小细胞癌的临床特点和综合治疗

目的：探讨原发性食管小细胞癌（PESC）的临床特点和综合治疗方法．方法：分析50例PESC的临床资料，其中放、化疗16例，单纯手术11例，术后联合放、化疗17例，术前化疗6例，分析其中位生存时间、结果：全组手术根治切除率为85．2％，手术死亡2例。放、化疗的中位生存时间7．2个月，单纯手术的中位生存时间为11个月．术后联合放、化疗的中位生存时间为16个月，术前化疗的中位生存时间为22个月。结论：PESC是一种全身性疾病．恶性程度较高，应采用综合治疗以达到延长生存的目的，特别是采用术前化疗的方法值得重视。     

食管癌个体化综合治疗的研究

 随着手术、放疗、化疗、分子靶向治疗的发展和日益成熟,多学科治疗已成为食管癌的主要治疗手段,任何单一治疗方式都难以提高食管癌的疗效。临床研究发现,根据不同患者,有目的地制定个体化的多学科综合治疗方案,将是降低复发率、提高生存率和改善生活质量的主要方式。     

口腔鳞癌卡铂,平阳霉素,氨甲喋呤术前诱导化疗的临床研究

目的:探讨卡铂,平阳霉素,氨甲喋呤术前诱导化疗对口腔鳞癌的临床效应.方法:45例32-72岁的口腔鳞癌患者,采用卡铂,平阳霉素,氨甲喋呤术前诱导化疗1个周期,化疗后3-5天,对常规检查正常者再进行手术治疗,对其近期疗效进行评价,随访3-5年.结果:诱导化疗后80%的患者肿瘤缩小50%以上,39 例手术患者近期疗效评价中,完全缓解 1例,部分缓解14例,无效16例;术后3、5年生存率分别为71.2%、66.7%.结论:卡铂,平阳霉素,氨甲喋呤用于口腔鳞癌术前诱导化疗,具有较满意的临床效果,与相应的手术相结合可以提高患者远期生存率.     

A three-step strategy of induction chemotherapy then chemoradiation followed by surgery in patients with potentially resectable carcinoma of the esophagus or gastroesophageal junction

BACKGROUND: Patients with locoregional carcinoma of the esophagus or gastroesophageal junction have a poor survival rate after surgery. Preoperative chemotherapy or chemoradiotherapy has not improved the outcome for these patients. Our study was designed to assess the feasibility of preoperative induction combination chemotherapy in addition to chemoradiotherapy to improve the curative resection rate, local control, and survival. PATIENTS AND METHODS Patients having histologic proof of localized carcinoma (either squamous cell carcinoma or adenocarcinoma) of the esophagus or gastroesophageal junction underwent full classification including endoscopic ultrasonography (EUS). Patients first received up to two courses of induction chemotherapy consisting of 5-fluorouracil at 750 mg/m(2)/day as continuous infusion on Days 1--5, cisplatin at 15 mg/m(2)/day as an intravenous bolus on Days 1--5, and paclitaxel at 200 mg/m(2) as a 24-hour intravenous infusion on Day 1. The second course was repeated on Day 29. This was followed by radiotherapy (45 grays in 25 fractions) and concurrent admission of 5-fluorouracil (300 mg/m(2)/day as a continuous infusion 5 days/week) and cisplatin (20 mg/m(2) on Days 1--5 of radiotherapy). After chemoradiotherapy, patients underwent surgery. The feasibility of this approach, curative resection rates, patient survival, and patterns of failure were assessed. RESULTS: Thirty-seven of 38 patients enrolled were evaluable for toxicity and survival. Adenocarcinoma and distal esophageal location of carcinoma were observed frequently. Thirty-five (95%) of the 37 patients underwent surgery, all of whom had an R0 (curative) resection. A pathologic complete response was noted in 11 (30%) of the 37 total patients. In addition, 5 patients (14%) had only microscopic carcinoma. According to EUS classification, 31 (89%) of the 35 patients who underwent surgery had a T3 carcinoma whereas according to pathologic classification only 3 (9%) had a T3 carcinoma (P 相似文献