乳腺癌保乳术中近距离瘤床放疗的临床应用评估

目的:探讨早期乳腺癌保乳术中采用近距离瘤床放疗取代常规术后全乳放疗后瘤床加量外照射的安全性和可行性.方法:共入组30例患者,其中15例早期乳腺癌患者接受保乳术中近距离瘤床放疗,术后常规行全乳放疗;另选择15例早期乳腺癌患者作为配对,接受保乳手术及术后全乳和瘤床加量放疗.比较2组患者术后24～48 h残腔引流量、切口Ⅰ期愈合率、术后住院天数和乳房外形满意度.结果:研究组与对照组的术后24～48 h残腔引流量、切口Ⅰ期愈合率、平均住院天数及辅助化疗开始时间的差异均无统计学意义(P＞0.05).2组患者的短期随访结果显示,均能保持满意的乳房外形.结论:早期乳腺癌保乳术中近距离瘤床放疗具有较好的安全性和临床可操作性.     

早期乳腺癌保乳术后瘤床同步加量短疗程放疗临床观察

目的 探讨早期乳腺癌保乳术后瘤床同步加量短疗程放疗疗效、不良反应以及美容效果。方法 2008—2010年本院收治早期乳腺癌保乳术后患者 306例,其中 160例行常规分割放疗(常规组),两野切线全乳照射,后续瘤床电子线推量,总疗程 46~48 d;146例行短疗程放疗(短程组),两野切线全乳照射,同步瘤床电子线推量,总疗程 30~32 d。Kaplan-Meier法计算生存率和局部复发率并Logrank检验差异,χ²检验两组资料可比性、不良反应及美容效果。结果 中位随访时间26个月,随访率为100%。两组1、2、3年生存率均为100%,均无局部复发(χ²=0.00,P=1.000)。常规组与短程组1、2级急性皮肤反应发生率分别为46.9%与45.1%(χ²=0.73,P=0.695)、16.3%与13.7%(χ²=0.73,P=0.695),1级皮肤及皮下组织晚期反应发生率分别为16.9%与17.1%(χ²=0.00,P=0.954);1级中性粒细胞减少发生率分别为11.9%与13.7%(χ²=0.23,P=0.633);美容优良率分别为66.2%与65.5%(χ²=0.01,P=0.927)。结论 保乳术后全乳放疗同步瘤床加量的短疗程方案与常规放疗的疗效相似,美容效果相当且未加重皮肤反应,但还需进一步研究。     

基于VMAT的乳腺癌保乳术后全乳混合调强技术的建立与评价

目的 建立基于VMAT的乳腺癌保乳术后全乳混合调强技术并评价其临床应用价值。方法 选取10例乳腺癌保乳术后患者,分别基于固定角度IMRT的混合调强技术和基于VMAT的混合调强技术设计两组放疗计划。第1组仅以全乳作为放疗靶区,处方剂量50 Gy分25次完成;第2组以全乳及瘤床同步加量区为放疗靶区,处方剂量全乳50 Gy、瘤床同步加量区60 Gy,分25次同步完成。分别比较两组计划的剂量学参数及计划执行效率。配对t检验差异。结果 与基于固定角度IMRT的混合调强技术相比,基于VMAT的混合调强技术未能提高单纯全乳照射者靶区CI、HI值(P=0.866、0.056),反而全面增加了OAR受量和调强野机器跳数(P=0.000~0.050和P=0.002);但对全乳加瘤床同步加量照射患者,能减少肺受量、脊髓受量、调强野机器跳数、计划执行时间(P=0.004、0.001、0.000、0.000)。结论 对全乳加瘤床同步加量照射患者,基于VMAT的混合调强技术能更好保护OAR,提高计划执行效率,具有较高的临床应用潜力。     

早期乳腺癌保乳术后简化逆向调强放疗的剂量学研究

目的：比较早期乳腺癌保乳术后三维适形放疗（3DCRT）及简化逆向动态调强放疗（IMRT）剂量学特点。方法随机选择14例早期乳腺癌保乳术后患者（4例左侧乳腺癌）,每例患者选用6 MV-X线分别设计3DCRT、IMRT计划,全乳腺50 Gy/25次。3DCRT组：采用切线野照射,瘤床区不加量;IMRT组：采用逆向动态调强技术,以2对类切线野为调强主野的入射方向,瘤床区同步加量10 Gy/25次。根据剂量体积直方图（DVH）进行适形度指数（CI）及不均匀度指数（HI）、危及器官受照射剂量及体积的评价。结果与3 DCRT计划比较,IMRT计划降低了患侧肺、左侧乳腺癌患者心脏的高剂量受照体积,提高了其低剂量受照体积,DVH叉点剂量分别为（25．16±9．11）Gy、（28．63±10．41）Gy;IMRT组和3DCRT组计划健侧乳腺的V10差异无统计学意义[（4．13±5．17）％∶（1．99±2．43）％,t＝2．11,P＞0．05],IMRT计划D30、平均剂量均较3DCRT增高[（2．23±1．77）Gy ∶（1．20±0．46）Gy,t＝2．58,P＜0．05;（2．35±1．59）Gy ∶（1．54±0．88）Gy,t＝3．15,P＜0．01）];2组计划的HI差异无统计学意义[（1．25±0．10）∶（1．23±0．11）,t＝1．25,P＞0．05],IMRT计划CI 高于3DCRT[（0．75±0．07）∶（0．62±0．09）,t＝5．68,P＜0．0001]。结论早期乳腺癌保乳术后四野简化逆向动态 IMRT技术较3 DCRT技术的主要优势在于瘤床同步加量,同时可以降低患侧肺的高剂量受照射体积,明显改善计划靶区CI,但HI无显著改善。早期乳腺癌保乳术后四野简化逆向动态IMRT技术是一种简便、合理、可行的计划设计方法。     

乳腺癌保乳术后同步加量调强放疗的临床疗效

目的:探讨乳腺癌保乳术后同步加量调强放疗的疗效、不良反应及美容效果。方法:2008年~2010年收治乳腺癌保乳术后患者78例,其中38例行瘤床同步加量调强放疗（A组）,剂量分割方案为全乳50Gy/25次（2Gy/次）,瘤床同步加量至60Gy/25次（2.4Gy/次）,总疗程33~35天;40例行常规分割调强放疗（B组）,剂量分割方案为全乳50Gy/25次,后续瘤床推量10Gy/5次（2Gy/次）,总疗程40~42天。应用Kaplan-Meier法生存分析,Log-rank法检验差异。结果:中位随访时间为73个月,随访率为100%。两组5年总生存率均为100%。A组和B组5年局部无复发生存率、无病生存率分别为97.4%、97.5%（P=0.978）;97.4%、95.0%（P=0.589)。A组和B组1、2级急性皮肤反应发生率分别为57.9%、52.5%(P＝0.632); 13.2%、12.5%(P＝0.931);A组和B组的1级皮肤及皮下组织晚期反应发生率分别为15.8%、15.0%（P=0.932）;1级白细胞减少发生率分别为7.9%、10.0%（P=0.745）。A组和B组在放疗前、放疗后3、5年美容效果优良率分别为86.8%、87.5%（P=0.931）;84.2%、85.0%（P=0.932）;81.6%、82.5%（P=0.916）。结论:保乳术后同步加量调强放疗的疗效与常规分割调强放疗相似,美容效果及不良反应相当。     

大分割放疗治疗保乳手术后早期乳腺癌的疗效及安全性

目的 探讨常规放疗与大分割放疗对行保乳手术早期乳腺癌患者的疗效及安全性.方法 保乳手术早期乳腺癌患者共120例,以随机区组法分为常规放疗组(60例)和大分割放疗组(60例),术后分别行常规放疗(总放射剂量50 Gy/25 f,瘤床加量10 Gy/5 f)与大分割放疗(总放射剂量42.4 Gy/16 f,瘤床加量10 Gy/4 f)治疗.比较两组患者生存率、复发转移率、美容效果优良率及不良反应发生率等.结果 两组患者1、2、3年生存率比较差异均无统计学意义(98.3％ vs 100.0％,93.3％vs96.7％,88.3％vs90.0％,均P＞0.05),3年局部复发率和远处转移率比较差异均无统计学意义(5.0％ vs 1.7％,10.0％ vs 6.7％,均P＞0.05),美容效果优良率比较差异无统计学意义(88.3％ vs 90.0％,P＞0.05),不良反应发生率比较差异无统计学意义(P＞0.05).结论 常规放疗与大分割放疗用于行保乳手术早期乳腺癌患者具有相似临床疗效及安全性,而大分割放疗方案具有放疗次数少、疗程短及经济性好等优势.     

保乳术后瘤床放疗的研究进展

早期乳腺癌术后单纯瘤床放疗是指保乳术后在较短时间内完成对瘤床的照射.主要有近距离治疗和适形放疗两种治疗方式,其中对近距离治疗的研究较多.目前保乳术后单纯瘤床放疗仍为试验性研究.     

早期乳腺癌保乳术后全乳大分割照射同步瘤床加量的临床分析

目的：观察早期乳腺癌保乳术后全乳大分割照射同步瘤床加量的短期疗效与不良反应。方法64例早期乳腺癌患者保乳术后行两野切线全乳照射,全乳腺照射40．5 Gy／15 f,单次剂量2．7 Gy／f,同步瘤床推量至48 Gy／15 f,单次剂量3．2 Gy／f,总疗程3周,观察分析患者局部复发情况、美容效果及不良反应。结果中位随访时间17月,随访率为100％,无局部复发情况发生。3例患者表现乳腺中度胀痛;Ⅰ、Ⅱ、Ⅲ级急性皮肤反应发生率分别为17．2％、4．7％、1．6％;Ⅰ级血小板下降发生率与Ⅰ～Ⅱ级中性粒细胞减少发生率分别为1．6％、4．7％;放疗完成后4、7月美容优良率分别为90．6％、87．5％。结论早期乳腺癌保乳术后全乳放疗同步瘤床加量的短期疗效与以往常规放疗方式相似,缩短放疗时间,不会增加皮肤不良反应及降低美容效果。     

保乳术后瘤床放疗的研究进展

早期乳腺癌术后单纯瘤床放疗是指保乳术后在较短时间内完成对瘤床的照射。主要有近距离治疗和适形放疗两种治疗方式 ,其中对近距离治疗的研究较多。目前保乳术后单纯瘤床放疗仍为试验性研究     

左侧乳腺癌保乳术后3种放疗技术在同步推量中的剂量学研究

目的 探讨左侧乳腺癌保乳术后半弧容积动态旋转调强(VMAT)放疗、切线弧VMAT放疗和逆向调强放疗(IMRT)3种放疗技术在同步推量中的剂量学差异.方法 选取10例左侧乳腺癌保乳术后患者,使用MONACO 5.1计划系统,分别采用半弧VMAT、切线弧VMAT和IMRT三种放疗技术,处方剂量均为计划靶区(PTV)50 Gy/25 f、计划肿瘤靶区(PGTV)60 Gy/25 f,评估3种计划靶区剂量适形度指数(CI)、均匀性指数(HI)以及周围正常组织器官的受照剂量.结果 半弧VMAT的PGTV靶区CI优于IMRT(P﹤0.05).切线弧VMAT放疗技术较IMRT放疗技术降低了左侧乳腺癌保乳术后患者患侧肺组织V10的照射范围(P=0.04).切线弧VMAT放疗技术较半弧VMAT放疗技术降低了左侧乳腺癌保乳术后患者健侧肺组织V5(P﹤0.001)、V10(P=0.04)、心脏的V10(P=0.01)、Dmean(P=0.01)及健侧乳腺组织V5(P﹤0.01)的剂量范围.而IMRT放疗技术降低了左侧乳腺癌保乳术后患者健侧肺组织V5、V10的剂量范围(P﹤0.05).结论 对于左侧乳腺癌保乳术后患者的同步推量放疗,VMAT放疗技术尤其是半弧VMAT放疗技术具有更好的靶区适形性;切线弧VMAT放疗技术可以降低周围大部分正常组织器官的照射剂量.     

ER及Her-2对乳腺癌治疗策略的影响

乳腺癌是高度异质性肿瘤,多种生物学指标对治疗的选择产生了巨大的影响.其中,雌激素受体(ER)和人表皮生长因子受体2(Her-2)是非常重要的因素,它们既影响乳腺癌的预后,又是预测乳腺癌多种治疗方案疗效的预测因子.深入了解这两项指标,可以制定出更个体化的治疗方案,从而避免治疗的不足或治疗过度,有效地降低药物的耐药性,进一步改善治疗效果.     

BRCA1和EGFR是多西他赛联合顺铂方案治疗的三阴性乳腺癌预后的重要标志物

Hugh J,Hanson J,Cheang MCU,et al.Breast cancer subtypes and response to docetaxel in node-positive breast cancer:use of an im-munohistochemical definition in the BCIRG 001 trial.J Clin Oncol,2009,27:1168-1176.

Gluz O,Liedtke C,Gottschalk N,et al.Triple-negative breast can-cer-current status and future directions.Ann Oncol,2009,20:1913-1927.

Le Doussal V,Tubiana-Hulin M,Friedman S,et al.Prognostic value of histologic grade nuclear components of Scarff-Bloom-Richardson (SBR).An improved score modification based on a multivariate analysis of 1262 invasive ductal breast carcinomas.Cancer,1989,64:1914-1921.

Lee WY,Jin YT,Chang TW,et al.Immunolocalization of BRCA1 protein in normal breast tissue and sporadic invasive ductal carcinomas:a correlation with other biological parameters.Histopathology,1999,34:106-112.

Bhargava R,Gerald WL,Li AR,et al.EGFR gene amplification in breast cancer:correlation with epidermal growth factor receptor mRNA and protein expression and Her-2 status and absence of EGFR-activating mutations.Mod Pathol,2005,189:1027-1033.

Therasse P,Arbuck SG,Eisenhauer EA,et al.New guidelines to evaluate response to treatment in solid tumors.J Nat Cancer Inst,2000,92:205-216.

Common terminology criteria for adverse events v3.0 (CTCAE).Cancer therapy evaluation program,DTCD,NCI,NIH,DHHS,March,2003.Available at:http://ctep.cancer.gov.August 9,2006.

Husain A,He G,Venkatraman ES,et al.BRCA1 up-regulation is associated with repair-mediated resistance to cis-diammine dichloro-platinum (II).Cancer Res,1998,58:1120-1123.

Goffin JR,Chappuis PO,Begin LR,ef a/.Impact of germ line BRCA1 mutations and overexpression of p53 on prognosis and response to treatment.Following breast carcinoma:10-year follow up data.Cancer,2003,97:527-536.

Delaloge S,Pelissier P,Kloos,L,et al.BRCA1-linked breast cancer (BC) is highly more chemosensitive than its BRCA2-linked or sporadic counterpart (abstract).Ann Oncol,2002,13 (suppl 5):34.

James CR,Quinn JE,Mullan PB,et al.BRCA1:a potential predictive biomarker in treatment of breast cancer.Oncologist,2007,12:142-150.

Jensen RA,Thompson ME,Jetton TL,et al.BRCA1 is secreted and exhibits properties of a granin.Nature Genet,1996,12:303-308.

Comanescu M,Popescu CF.BRACA1 expression in invasive breast carcinomas and clinicopathological correlations.Romanian J Morphol Embryol,2009,50:419-424.

Gudas JM,Nguyen H,Li T,et al.Hormone-dependent regulation of BRCA1 in human breast cancer cells.Cancer Res,1995,55:4561-4565.

Liu S,Ginestier C,Charafe-Jauffret E,et al.BRCA regulates human mammary stem progenitor cell Fate.Proc Natl Acad Sci USA,2008,105:1680-1685.

Yoshikawa K,Honda K,Inamoto T,et al.Reduction of BRCA1 protein expression in Japanese sporadic breast carcinomas and its frequent loss in BRCA1 -associated cases.Clin Cancer Res,1999,5:1249-1261.

Nielsen TO,Hsu FD,Jensen K,et al.Immunohistochemical and clinical characterization of the basal-like subtype of invasive breast carcinoma.Clin Cancer Res,2004,10:5367-5374.

Toyama T,Yamashita H,Kondo N,et al.Frequently increased epidermal growth factor receptor (EGFR) copy numbers and decreased BRCA1 mRNA expression in Japanese triple-negative breast cancers.MBC Cancer,2008,8:309-321.

Rhee J,Han SW,Oh DY,et al.The clinicopathologic characteristics and prognostic significance of triple-negativity in node-negative breast cancer.BMC Cancer,2008,8:307.

Corkey B,Crown J,Clynes M,et al.Epidermal growth factor receptor as a potential therapeutic target in triple-negative breast cancer.Ann Oncol,2009,20:862-867.

Tischkowitz M,Brunet JS,Begin LR,et al.Use of immunohistochemical markers can refine prognosis in triple negative breast cancer.BMC cancer,2007,7:134-145.

Dent R,Trudeau M,Pritchard K,et al.Triple negative breast cancer:clinical features and patterns of recurrence.Clin Cancer Res,2007,13:4429-4434.

Harris LN,Broadwater G,Lin NU,et al.Molecular subtypes of breast cancer in relation to paclitaxel response and outcomes in women with metastatic disease:results from CALGB 9342.Breast Cancer Res,2006,8:R66.

Bouchalova K,Cizkova M,Cwiertka K,et al.Triple negative breast cancer-current status and prospective targeted treatment based on Her1 (EGFR),TOPA2 and C-MYC gene assessment.Biomed Pap Med Fac Palacky Olomouc Czech Repub,2009,153:13-18.

Sirohi B,Arnedos M,Popat S,et al.Platinum-based chemotherapy in triple negative breast cancer.Ann Oncol,2008,19:1847-1852.

Byrski T,Huzarski T,Dent R,et al.Response to neoadjuvant therapy with cisplatin in BRCA1 -positive breast cancer patients.Breast Cancer Res Treat,2009,115:359-363.

>>更多...     

Factors determining cosmetic results after periareolar excisional biopsy of benign breast lesions

Objective To assess the factors that determine cosmetic results after periareolar excisional biopsy for the management of Breast Imaging- Reporting and Data System （BI-RADS） 3 and 4 breast lesions. Methods Potential risk factors for adverse cosmetic results of incision after periareolar excisional biopsy were evaluated in 74 patients （7 people had bilateral breast operations） undergoing a single biopsy after suspicion of a malignant lesion that subsequently proved to be benign. The overall cosmetic result was evaluated using a modification of the European Organisation for Research and Treatment of Comcer （EORTC） cosmetic indices individually scored 6 months after the breast excisional biopsy. To evaluate the factors affecting cosmetic outcome of incision, an analysis of variance was undertaken using the Kruskal-Wallis test for continuous variables and the chi-squared and Fisher exact tests for categorical variables. Based on cosmetic outcome of incision as dependent variables, and patient＇ s age, incision location, scar color respectively as independent variables, multivariate analysis was performed with logistic regression for screening the factors. Results Out of 81 operated breasts, the cosmetic result of incision was rated as excellent （0 score） in 19 （23.46%）, good （1 score） in38 （46.91%）, fair （2 scores） in 14 （17.28%）, and poor （3 scores） in 10 （12.34%）. Univariate analysis shows that age, incision location and scar color affected cosmetic result. Older patients, with no scar or white scar, and the inferior or lateral periareolar incision had better cosmetic outcomes of incision. Patients more than 45 years had better cosmetic outcomes of incision than those less than 31 years （P = 0. 0231 ）. Patients with the inferior or lateral periareolar incision obtained better cosmetic outcomes than those with the superior or medial incision. Patients with no scar obtained better cosmetic outcomes than those with white scar or red scar. Conclusions The cosmetic outcomes after periareolar excisional biopsy of benign breast lesions are excellent or good in most of cases. Age, incision location and scar color all affect cosmetic results of incision.     

Role of molecular markers in breast cancer therapy

<正>Translational research,in general,means to take knowledge from one area into a second.Traditional thought to represent transfer of knowledge from basic research into the clinic,translational research today covers a much broader term.Thus,most investigators will agree translational research covers a two-way process that also includes taking lessons from the clinic back to the laboratory,by which biological observations in vivo would create novel hypotheses to be further explored in laboratory experiments.     

P21-activated kinase 1 and breast cancer

<正>The p21-activated kinase 1(PAK1)belongs to PAKs family,a group of highly evolutionarily conserved protein family of serine/threonine kinases,which acts as a downstream effector of the small GTPases Cdc42 and Rac1,firstly reported in 1994[1].As a serine/threonine kinase,PAK1 plays an important role in many cellular functions including cell morphogenesis,motility,survival,mitosis,angiogenesis,     

居家癌痛患者家属的心理状态及相关因素的分析

疼痛是癌症患者最常见的、最难以忍受的症状之一,是患者及家属极大的应激源。研究发现,患者和家属的心理状态是相互影响的[1]。本研究旨在了解居家癌痛患者家属心理状态及相关因素,更好地为居家癌痛患者提供家庭及社会支持,提高其生活质量。     

宫颈癌放化疗前后的影像学特征变化分析

<正>我国宫颈癌发病率为1400/10万左右,每年新发病例约为14万人[1-2]。手术、放疗及化疗为主的综合治疗是宫颈癌治疗的主要方法,其中手术切除适应于临床分期Ⅰa-Ⅱa期患者,放疗适用于不能耐受手术者及Ⅱb、Ⅲ、Ⅳ期患者[3-4],化疗作为手术或放疗的辅助治疗,用于治疗宫颈癌[5]。而随着影像学技术的快速发展,MRI与CT检查已广泛地应用于临床中,其中多层螺旋CT灌注成像与增强MRI使得诊断的空间分辨率增加,从而使诊断更准确[6-7]。我们探讨了宫颈     

化疗后老年肿瘤患者肝损害探析

老年肿瘤发病率呈现上升趋势。由于老年患者身体机能有不同程度的下降,各类合并症较多,因而在肿瘤化疗中风险会有一定增加。化疗肝损害是一种较常见的不良反应,为进一步研究化疗后老年肿瘤患者肝损害因素及特征,我们对2009年1月至2012年1月收治的82例老年肿瘤患者化疗期间肝损伤情况进行了回顾性分析。现报道如下。     

Potential of a COX-2 inhibitor in lowering ：hemotherapy-induced neutropenia

Objective This study was initially designed to evaluate the effect of celecoxib on the regimen of 5-fluorouracil,epirubicin,and cyclophosphamide（FEC）combination,followed by docetaxel（T）in neoadjuvant setting.An unplanned preliminary review on safety was conducted after a halt of the study due to the concerned potential cardiovascular risk of using COX-2 inhibitors.Methods We studied 23 consecutive cases of operable breast cancer having received four cycles of FEC（500 mg/m2,100 mg/m2,500 mg/m2）followed by four cycles of T（100 mg/m2）with concurrent celecoxib（400 mg twice daily）（group A）or same chemotherapy regimen but without concurrent celecoxib（group B）.These combined chemotherapies were administered every 3 weeks.The Chi-square test or Fisher＇s exact test were used to assess the difference in incidence of limiting hematological toxicites between groups.Results 23 patients（group A：n=12;group B,n=11）received a total of 183 out of 184 planned treatment cycles;one（4%,1/23）of them omitted the fourth cycle of FEC owing to repeated incidences of febrile neutropenia.Received dose intensity（RDI）for FEC in group A（90%±11%）was higher than that in group B（80%±8%）while RDI for T was similar between group A（93%±8%）and group B（96%±9%）.Of the first 91 treatment cycles of FEC,limiting hematological toxicity,severe neutropenia including febrile neutropenia,was significantly different between group A and B [（10.4%,5/48）vs.（32.6%,14/43）,P=0.009].Other toxicities commonly observed in chemotherapy receiving patients were manageable.Conclusions Neoadjuvant use of FEC followed by T with concurrent celecoxib appeared to be safe for treatment of operable invasive breast cancer.The observed lower incidence of chemotherapy-induced neutropenia is possibly contributed by the administration of COX-inhibitor.We believe that further investigation might provide more evidence on the use of COX-2 inhibitors in breast cancer.     

高精度放射治疗儿童肿瘤患者的心理分析及相应的护理对策

近年来,随着社会环境的改变,儿童恶性肿瘤患病率呈显著上升趋势。儿童患恶性肿瘤不仅对于患儿自身来说是一种灾难,对于其家庭也会产生灾难性的影响。随着医疗水平的提高,这类患者的预后得到显著改善,但是儿童正是处于生长和发育的关键时间,身心尚未成熟,对周围环境的适应能力相对较差,对于父母的依赖性相对较强,在治疗过程中合作性相对较差。