放射性肠炎临床诊疗新进展

小肠胶囊内镜与双气囊小肠镜检查逐渐成为临床诊断放射性肠炎(RE)的新手段, 尤其是对异常肠道组织的诊断。靶向活检或介入治疗有望实现RE的精准治疗。而筛选生物样本中的分子标志物也成为RE诊断新方向。粪便微生物群移植已成为具有前景的RE治疗手段之一, 此外基于传统中草药、靶问细胞死亡以及组学分析的机制研究为RE的诊疗提供了新策略。     

放射性肠炎诱发及加重因素探究

放射性肠炎是腹腔和盆腔肿瘤放射治疗后的常见并发症。随着恶性肿瘤发病率的持续增高和放射治疗的广泛运用,放射性肠炎的发病率也逐年攀升。目前,临床对放射性肠炎的认识不够深入,且尚没有系统的指南对放射性肠炎进行诊断、分级和治疗,因此,多以放射治疗后出现腹泻、便血等症状及病理上的肠道炎性损伤为诊断依据,不够规范。放射剂量与放射性肠炎密切相关,诱发和加重因素对放射性肠炎分级治疗影响较大,本文将放射性肠炎可能的诱发及加重因素简单总结为损害因素、防御因素和其他因素。     

放射性肠炎内镜与影像诊断进展

摘 要：放射性肠炎是盆腔、腹腔或腹膜后病变经放射治疗后引起的肠道并发症,不仅增加患者的痛苦,降低生活质量,并影响预后。放射性肠炎的早期诊断越来越受到重视,而内镜及影像学检查是诊断放射性肠炎的主要手段。全文从内镜及影像学的角度,分析及总结放射性肠炎的诊断进展。     

中医药治疗放射性肠炎的研究进展

放射性肠炎(RE)是腹腔、盆腔或腹膜后恶性肿瘤经放射治疗后引起的肠道并发症,可分别累及小肠、结肠和直肠.腹腔或盆腔放疗期间,60％～70％的患者出现急性胃肠道症状.放射线对肠管的损害不仅可发生在放疗期间,还可延续至治疗后的10余年.近年来,RE的发病率呈逐渐上升趋势,但目前尚无药物防治的标准策略.而近年来,大量关于中医药防治RE的临床研究表明,中医药治疗RE取得了可喜的疗效,因此,本文就中医药治疗RE的研究进展作一综述.     

放射性肠炎临床治疗现状评述

放射性肠炎（radiation enteritis,RE）是盆腹腔恶性肿瘤接受放射治疗引起的常见肠道并发症,主要表现为腹痛腹泻、里急后重、肛门坠痛、粘液便、便血等。轻者症状可耐受,重者症状持续很长时间,常伴有慢性出血,并可能发展为直肠狭窄或形成肠瘘。     

对放射性肠炎的认识及其可能的机制探讨

放射性肠炎严重影响盆腔肿瘤放疗患者的生活质量,作为一种放疗相关的肠道炎症,相关的基础研究显示放射性肠炎本质上是一种黏膜的炎症,由于程序性坏死可能介导了炎症性肠病的发生,因此,同样作为肠道炎症性疾病的一种,程序性坏死可能也介导了放射性肠炎的发生发展。本文拟对放射性肠炎的本质以及可能的发生机制进行综述,期待能够指导放射性肠炎的治疗,进而有望提高患者的生活质量。     

放射性肠炎的中西医治疗研究进展

放射性肠炎是腹腔、盆腔或腹膜后恶性肿瘤放射治疗后引起的肠道并发症,可累及小肠及结、直肠.腹腔或盆腔放疗期间,约60%-70%病人出现急性胃肠道症状.近年来发病率呈上升趋势,但治疗较为棘手,目前尚无药物预防及治疗的标准策略.西医主要以营养支持、高压氧治疗、手术及对症治疗为主要手段.中医学认为,肿瘤病人正气不足,加之毒邪入侵,正虚邪盛,致脏腑、气血、津液受损是放射性肠炎的基本病机,属本虚标实证.治疗以扶正祛邪,急则治标为基本原则,临床采用辨证论治方法治疗,中药灌肠及针灸疗法也越来越多地应用于临床.     

氩离子凝固术加黏膜下药物注射治疗放射性肠炎初步临床分析

目的 初步探讨内镜下氩离子凝固术(APC)联合黏膜下去甲肾上腺盐水注射治疗放射性肠炎的临床疗效,尤其是对难治性放射性肠炎的疗效评估。方法 回顾分析22例患者临床资料,分别采用改良内镜评分法(A)和Sherman′s classification (B)对患者进行严重程度评分。治疗成功的标准是临床症状的改善或便血停止(或仅有少量便血不需要进一步干预)。结果 22例患者疗后均达到临床症状改善,其中18例(82%)便血完全停止。A评估法:轻度肠炎15例(68%),重度肠炎7例(32%)。B评估法:轻度9例(41%),重度13例(59%)。采用A评估法进行相关分析发现,治疗次数与内镜等级(或内镜评分)有很好的相关性(r=0.86,P<0.001)。结论 初步证明内镜下APC联合黏膜下去甲肾上腺盐水注射治疗放射性肠炎不仅对轻-中患者有效,对难治性放射性肠炎同样可维持长久疗效。A评估法更适合在临床中推广。     

氩离子凝固术加黏膜下药物注射治疗放射性肠炎初步临床分析

目的 初步探讨内镜下氩离子凝固术(APC)联合黏膜下去甲肾上腺盐水注射治疗放射性肠炎的临床疗效,尤其是对难治性放射性肠炎的疗效评估。方法 回顾分析22例患者临床资料,分别采用改良内镜评分法(A)和Sherman′s classification (B)对患者进行严重程度评分。治疗成功的标准是临床症状的改善或便血停止(或仅有少量便血不需要进一步干预)。结果 22例患者疗后均达到临床症状改善,其中18例(82%)便血完全停止。A评估法:轻度肠炎15例(68%),重度肠炎7例(32%)。B评估法:轻度9例(41%),重度13例(59%)。采用A评估法进行相关分析发现,治疗次数与内镜等级(或内镜评分)有很好的相关性(r=0.86,P<0.001)。结论 初步证明内镜下APC联合黏膜下去甲肾上腺盐水注射治疗放射性肠炎不仅对轻-中患者有效,对难治性放射性肠炎同样可维持长久疗效。A评估法更适合在临床中推广。     

放射性肠炎中医药治疗研究进展

放射性肠炎是恶性肿瘤患者接受腹盆腔放疗后的一种常见并发症。治疗较为棘手,目前尚无标准的治疗方法。近年来中医药在治疗放射性肠炎方面取得了良好效果,主要包括：辨证论治、验方治疗、中成药治疗、中药保留灌肠治疗及中西医结合治疗等。     

Radioembolization of hepatic tumors

Unresectable primary and metastatic liver tumors are a leading cause of cancer mortality and morbidity. This remains a challenging and key task for every oncologist despite significant advances that have been made with selective targeted systemic agents and in technology advances with radiotherapy delivery. Radioembolization (RE) is a technique of permanently implanting microspheres containing Yttrium-90 (⁹⁰Y), a beta-emitting isotope with a treatment range of 2 mm, into hepatic tumors. This form of brachytherapy utilizes the unique dual vascular anatomy of the liver to preferentially deliver radioactive particles via the hepatic artery to tumor, sparing normal liver parenchyma. The main treatment inclusion criteria are patients with solid tumors, compensated liver functions, life expectancy of at least three months, and ECOG performance status 0-2. Benefit of RE has been proven in patients that have low-to-moderate extrahepatic disease burden, prior liver radiotherapy, heavy prior chemotherapy and biologic agent exposure, and history of hepatic surgery or ablation. Most of the clinical evidence is reported in metastatic colorectal, and neuroendocrine tumors (NET), and primary hepatocellular cancer. A growing body of data supports the use of RE in hepatic metastatic breast cancer, intrahepatic cholangiocarinoma, and many other metastatic tumor types. Side effects are typically mild constitutional and GI issues limited to the first 7-14 days post treatment, with only 6% grade 3 toxicity reported in large series. Potentially serious or fatal radiation induced liver disease is extremely rare, reported in only 1% or fewer in major series of both metastatic and primary tumors treated with RE. Currently, high priority prospective clinical trials are testing RE combined with chemotherapy in first line therapy for colorectal hepatic metastases, and combined with sorafenib for hepatocellular carcinomas (HCCs). Fortunately, this beneficial and now widely available therapy is being increasingly incorporated into the standard therapy algorithms of multidisciplinary GI cancer teams worldwide. This form of radiotherapy differs significantly from daily external beam radiotherapy in many ways, particularly in dose rate, dosimetric coverage and duration of radiation delivery, side effects, and patient selection factors. A wealth of experience using RE in solid tumors exists and ongoing major prospective clinical trials will soon clarify the role of RE in the management of metastatic colorectal liver metastases.     

CT影像组学在指导肺癌精准放疗中的应用进展

肺癌的精确诊断、放疗敏感性和正常组织放射性损伤的准确预测是实现肺癌精准放疗的必要前提。影像组学（radiomics）作为肺癌精准治疗发展史上一个具有里程碑意义的辅助工具,可以通过应用自动和半自动算法对肺癌影像资料的感兴趣区域提取大量影像特征,寻找这些特征与临床诊疗数据之间的深层关系,揭示肺癌的发生、发展及临床转归规律。影像组学可以无创获取肺部肿瘤整体异质性信息,在良恶性肺结节的判定、肿瘤基因表型和放疗反应的预测等方面具有巨大临床应用潜能。本文就CT影像组学在辅助肺癌放疗方面的最新研究进行综述。      

垂体腺瘤诊断和治疗现状

垂体腺瘤是一种比较特殊的颅内肿瘤，既有肿瘤的性质，同时也有内分泌学特性。垂体腺瘤的危害主要有：垂体激素过量分泌，产生一系列代谢紊乱和脏器损害；肿瘤压迫使其它垂体激素低下，引起相应的靶腺功能低下：肿瘤压迫鞍区结构，导致相应功能严重障碍。其诊断和治疗也应从以上三方面考虑。核磁共振检查及内分泌激素测定是垂体腺瘤诊断的重要手段。近些年来，越来越多的人们认识到经蝶入路优于经颅入路。本文从垂体腺瘤诊断和治疗方面需要明确的几个问题予以概述：垂体腺瘤的早期诊断和治疗，垂体腺瘤诊断和治疗的规范化，疗效的评价，侵袭性垂体腺瘤以及垂体腺瘤放疗应注意的几个方面。     

Quantitative comparison of estradiol and progesterone receptor contents of primary and metastatic human breast tumors in relation to response to endocrine treatment

Summary Cytosol receptors for estradiol (RE) and progesterone (RP) in breast tumors from women attending one clinic have been analyzed. The analysis involved a single concentration of [³H] ligand and low speed centrifugation of homogenates. Analysis of tumors immediately before the start of first endocrine treatment indicated a poor response rate in patients with tumor RE <20 fmol/mg protein. A cut-off value of 20 fmol/mg protein gave the best discrimination between responders and nonresponders in both pre- and postmenopausal patients. An appreciable number of responses (17%) was seen with RP negative tumors (<5 fmol/mg protein) and analysis of this receptor alone is not recommended. Combined analysis of RE and RP indicated good response rates for RE+ RP+ (64%) and RE – RP+ (67%) tumors and a low response rate for RE– RP– (9%) tumors. Responses also occurred in patients with RE+ RP– tumors (30%). The influence of cut-off value and menopausal status on clinical usefulness of combined RE and RP analysis is discussed.Data are also presented on the clinical value of receptor analyses on primary tumors in predicting the endocrine sensitivity of subsequent metastatic disease.Receptor results for tumors obtained at different times from the same patient are presented and discussed. Receptor phenotype of some tumors does change with time and this is influenced by receptor amount, histological appearance, and intervening treatment.     

儿童中枢神经系统恶性肿瘤诊断与治疗

儿童脑瘤是儿童期最常见的恶性实体肿瘤,由一组异质性的疾病组成。其中髓母细胞瘤,幕上原始神经外胚叶肿瘤(SPNET)和原发中枢生殖细胞瘤(CNS GCT)是最常见的儿童青少年中枢神经系统恶性肿瘤。这些胚胎源性肿瘤对放疗化疗较敏感,手术联合放疗和化疗是标准的治疗。然而,全中枢放疗可导致生长发育迟缓和内分泌功能异常。国外已进行大量的联合化疗减少放疗剂量方面的临床研究。本文主要是复习有关儿童髓母细胞瘤、幕上原始神经外胚叶肿瘤和原发中枢生殖细胞瘤的临床研究及诊断和治疗的进展。     

肠道菌群对肺癌影响的研究进展

人体肠道内寄生着约十万亿个由500～1000不同种类组成的细菌，影响着人体消化和吸收功能、抵御感染和自身免疫疾病的患病风险，还参与药物代谢过程。肺癌的发病率和死亡率快速增长，是对人类生命威胁较大的恶性肿瘤。肠道菌群可能通过代谢或免疫等途径影响肺癌的发生，同时影响肺癌对放化疗、免疫治疗等治疗方法的疗效，但不同患者获益不一。肠道菌群在恶性肿瘤的发生、发展、诊断、治疗中的作用已成为近年来的研究热点，本研究对肠道菌群和肺癌的相关性研究进展进行综述。      

Evidence of cell kinetics as predictive factor of response to radiotherapy alone or chemoradiotherapy in patients with advanced head and neck cancer

PURPOSE: The aim of this study was to investigate the potential clinical relevance of cell kinetics parameters to the locoregional control (LRC) and overall survival of patients affected by head and neck squamous cell carcinoma (HN-SCC) treated by conventional radiotherapy, partly accelerated radiotherapy, or alternating chemoradiotherapy. METHODS AND MATERIALS: Between January 1993 and June 1996,115 patients with HN-SCC at Stage III and IV entered the study. Multiple primary tumor biopsies were obtained 6 h after in vivo infusion of bromodeoxyuridine (BrdUrd), an analogue of thymidine that is incorporated in DNA-synthesizing cells. In vivo S-phase fraction labeling index (LI), duration of S-phase (Ts), and potential doubling time (Tpot) were obtained by analysis of the flow cytometric content of BrdUrd and DNA. Eighty-two patients were randomly assigned to receive either alternating chemoradiotherapy or partly accelerated radiotherapy, whereas 33 other matching patients received conventional radiotherapy. RESULTS: Univariate LRC analysis showed that LI value was a prognostically significant factor, independent of type of therapy. Multivariate analysis failed to show cell kinetics parameters as statistically significant factors affecting LRC probability and overall survival. However, subgroup analysis showed that LRC probability at 4 years for fast proliferating tumors characterized by a LI >/= 8% was significantly better for patients treated either with alternating chemoradiotherapy or partly accelerated radiotherapy than it was for those treated with conventional radiotherapy. Conversely, LRC probability for slow proliferating tumors (LI < 8%) treated with the three treatment modalities was similar. CONCLUSIONS: These results showed that, independent of type of treatment, pretreatment cell kinetics provided only a weak prognostic role of outcome in HN-SCC. However, this report raises the hypothesis that fast growing HN-SCC may be more likely to benefit from intensified therapy, as given in this series. Cell kinetics parameters studied by the in vivo BrdUrd/flow cytometry method might be considered predictive factors of response, providing information on which type of treatment may be selected according to tumor proliferation rate.     

Radiation-induced sarcoma of head and neck: 50 years of experience at a single institution in an endemic area of nasopharyngeal carcinoma in China

Radiation-induced sarcoma in the head and neck (RISHN) is a rare condition whose clinical presentation and management remain difficult because of its low incidence. In this retrospective study, we analyzed the symptoms, diagnosis, and the treatment of 16,634 patients with head and neck disease, who received radiotherapy between 1960 and 2010 at the Affiliated Tumor Hospital and its predecessor, Guangxi Medical University, China. Among these patients, 16 with a first tumor of nasopharyngeal carcinoma (NPC) and 1 with squamous carcinoma of the tongue met the criteria of RISHN in the head and neck. Our epidemiological data showed that the incidence of RISHN rose from 0.06 to 0.17% from 1960 to 2010; the 3-year overall survival rate was 19.1%, and 3-year disease-free survival rate was 11.1%. The mean latency (SD) period was 93.2 (33) months. Based on the experiences at our institution, we suggest that RISHN is a rare complication after radiotherapy for head and neck tumors, especially NPC. Owing to its low incidence, it should not be a major factor affecting decisions about radiotherapy. Nevertheless, there may be a possibility of increasing incidence of RISHN after radiotherapy of NPC, as shown in our epidemiological results. Given the poor prognosis of RISHN, this possibility should be taken into serious consideration before determination of high-dose radiotherapy for patients with NPC and other head and neck tumors.     

Radiotherapy for symptomatic metastases to bone in children

Thirty-seven children less than age 19 years were treated from 1985 through 1998 with radiotherapy for symptomatic metastases to bone. The most common primary tumors were neuroblastoma (18), Ewing's sarcoma (5), and osteosarcoma (5). The interval from diagnosis of the primary tumor to treatment of the first symptomatic metastases involving bone ranged from 0 to 163 months (median 19). Thirty-seven children were treated with 150 courses of radiotherapy. Forty-three courses consisted of a single dose of 300 to 1,000 cGy. One hundred thirteen courses of radiotherapy consisted of five or fewer treatment fractions. Sixteen osseous sites were treated with two courses of radiotherapy and two sites were treated with three. The most commonly irradiated symptomatic bone sites were skull, spine, and hip/femurs. Survival from the first course of radiotherapy administered for metastases to bone varied from 1 to 52 months, with 11 patients (29.7%) surviving 12 or more months and only 3 patients (8.1%) surviving more than 2 years. The majority of children seemed to derive palliation from the radiotherapy based on assessment by family and medical personnel as well as by self-report in older patients. Children with symptomatic metastases to bone have an extremely poor prognosis, and short courses of radiotherapy are suggested as palliation. Repeat courses of radiotherapy can be given for persistent or recurrent symptoms.     

中药调节肠道菌群改善肿瘤恶液质作用的研究进展

肠道菌群与肿瘤相关性的研究目前仍是临床上一个值得期待的研究热点。肠道菌群失调与肿瘤恶液质的发生发展有着重大的联系。运用中药调节肠道菌群可以作为肿瘤放化疗后的辅助治疗，对机体的免疫调节起着很重要的作用，而肿瘤恶液质的发生与发展一定程度上会受到肠道菌群的影响，在肿瘤恶液质的防治中肠道菌群也起到了重要作用。从另一方面来讲，肿瘤恶液质的发生也会造成机体肠道菌群的失调，对于这种情况，用中药来对肠道菌群失调来进行调节，在一定程度上对肿瘤恶液质起到改善作用，通过中药调节肠道菌群对肿瘤恶液质的影响来探索中药、肠道菌群失调以及肿瘤恶液质三者之间的关系是本文所要阐述的，目的是促进祖国医学在肿瘤治疗方面发挥更大的效用，充分发挥中医的特色优势，尽早攻克肿瘤这个医学难题。