支架成形术结合动脉灌注化疗、放疗治疗晚期食管癌

目的探讨食管支架成形术结合动脉灌注化疗、放疗治疗晚期食管癌的疗效。方法56例晚期食管癌患者,在X线监视下,经口腔置入食道覆膜支架。支架成形术后7例患者单纯行动脉灌注化疗;13例患者单纯放疗;36例患者动脉灌注化疗术加放疗。结果所有患者支架置入均获成功,支架置入后吞咽困难症状得到不同程度缓解。在晚期食管癌的治疗中;支架置入术后同时结合动脉灌注化疗、放疗效果优于支架置入后单纯动脉灌注化疗或单纯放疗。结论支架成形术治疗晚期食管癌简单有效,支架成形术结合动脉灌注化疗、放疗可以延长患者的生存时间。     

胸中、上段Ⅲ期食管癌术前同步放化疗疗效分析

 目的 探讨术前同步放化疗对胸中、上段Ⅲ期食管癌患者手术切除率、术后并发症及预后的影响.方法 2002～2005年胸中、上段Ⅲ期食管癌175例,同步放化疗+手术组(A组)37例,单纯放疗+手术组(B组)61例,单纯手术组(C组)77例.A组化疗方案为:紫杉醇(TAX)135 mg/m2,第1天,顺铂20～30 mg/m2,第1～5天,21 d为1个周期,共用2个周期.分析术前同步放化疗对Ⅲ期胸中上段食管癌的治疗作用,比较3组患者的手术切除率、术后并发症发生率及远期疗效.结果 3组手术切除率分别为91.6%、88.1%、83.2%,术后并发症发生率分别为24.3%、19.7%、16.9%.A、B两组手术切除率显著高于C组(P<0.05),而A、B两组手术切除率无显著差异(P>0.05),术后并发症3组之间无显著差异(P>0.05).3组1年生存率分别为83.7%、75.4%、77.9%,3年生存率分别为33.2%、18.7%、19.1%,3组间1年生存率无明显差异,3年生存率A组显著高于B组、C组,B、C两组之间无差异.结论 术前同步放化疗可以显著提高手术切除率和远期生存率,而术后并发症与单纯放疗及直接手术患者相比未见明显增高.     

食管鳞癌细胞HIF-1α和COX-2表达及肿瘤组织微血管密度的临床意义研究

目的 研究食管鳞癌细胞HIF-1α和COX-2的表达和肿瘤微血管密度(MVD)与食管癌放疗疗效的关系。方法 应用免疫组织化学二步法对55例食管鳞癌食管镜活检组织中HIF-1α、COX-2的表达进行检测,并用同样方法检测癌组织中 CD34的表达评估MVD。分析其与临床病理学参数及放疗疗效的关系。结果 HIF-1α和COX-2的阳性表达率分别为92.7%和69.1%,MVD为2~29条/高倍视野,平均为(11.2±4.1)条。HIF-1α和COX-2的表达水平与MVD数量无关。HIF-α和COX-2的表达水平与肿瘤的细胞分化程度、肿瘤部位均无关。单因素分析示食管癌放疗后近期疗效中位生存期和2年生存率与HIF-1α、COX-2表达及MVD无关。结论 食管鳞癌组织中HIF-1α和COX-2的表达情况和肿瘤组织中微血管密度无关。 HIF-1α和COX-2 的表达水平及MVD均不能作为食管鳞癌放射治疗的预后指标。     

高压氧联合放射治疗对食管癌患者survivin蛋白表达的影响

目的 探讨食管癌患者survivin蛋白的表达及高压氧联合放射治疗对survivin蛋白表达的影响。方法 应用免疫组织化学SP法检测65例食管癌患者及20名正常人食管黏膜组织survivin蛋白表达情况。结果 食管癌患者survivin蛋白表达率为70.8％ (46/65),正常人食管黏膜组织中表达率为5％ (1/20)。survivin蛋白的表达与肿瘤的淋巴转移关系密切,有淋巴转移的患者survivin蛋白阳性率与无淋巴转移的患者比较差异有统计学意义(P＜0.05)。食道癌患者高压氧联合放射治疗与单纯放射治疗比较,临床症状有所改善,survivin蛋白阳性表达率降低,差异有统计学意义(P＜0.05)。结论 survivin蛋白阳性表达与食管癌的生长及转移有关,参与食管癌的发生发展。高压氧与放射治疗联合应用可提高临床疗效。     

甘氨双唑钠增敏三维适形放疗治疗气管食管沟淋巴结转移分析

目的探讨经甘氨双唑钠增敏的三维适形放射治疗食管癌气管食管沟淋巴结(TGLN)转移的近期疗效。方法 53例的食管癌TGLN转移患者按治疗方法不同分为治疗组(27例)和对照组(26例)。治疗组行三维适形放疗,同时在行放疗前给予甘氨双唑钠800 mg/m2,加入100 ml生理盐水静脉滴注,30 min内滴完,用药后1 h内放疗,每周3次(周1、3、5用药),连续用药至放疗结束;对照组行单纯放疗。两组放疗均采用常规分割,总剂量60 Gy。结果治疗组与对照组局部控制率(CR+PR)分别为81.5%(22/27)和50%(13/26),1年生存率分别为81.5%(22/27)和34.65%(9/26),两组比较差异有统计学意义(P<0.05)。不良反应主要表现为放射性食管炎和白细胞下降,多为Ⅰ、Ⅱ级。结论甘氨双唑钠增敏三维适形放疗治疗食管癌TGLN转移可提高局部控制率和近期疗效,副作用可耐受。     

沙利度胺联合放疗治疗食管癌的临床观察

目的 前瞻性研究沙利度胺干预下食管癌患者放疗过程中血清血管内皮生长因子(VEGF)水平的动态变化及近期疗效和耐受性.方法 采集86例食管癌患者放疗前、中、后的血清,应用酶联免疫吸附法( ELISA)测定血清VEGF水平,根据患者放疗中VEGF水平的变化给予沙利度胺干预,将83例(另外3例因不耐受放疗而中断治疗)患者分成服药组32例(放疗中VEGF水平升高或不变的患者给予口服沙利度胺至放疗结束)和未服药组51例(VEGF水平降低的患者不服用沙利度胺放疗至结束),观察沙利度胺干预下食管癌放疗的疗效及服用药物的安全性.另设30例健康对照组.结果 86例食管癌患者放疗前血清VEGF表达水平较30例健康对照者升高,差异有统计学意义(t=5.07,P＜0.01),且与原发肿瘤大小(t=4.55,P＜0.01)、淋巴结转移(t=7.50,P ＜0.01)、组织病理类型(F=3.40,P＜0.01)及临床分期均有关(t=2.52,P＜0.01),而与病变部位、远处转移、X射线分型、患者性别、年龄均无关(P均＞0.05).服药组患者放疗后较放疗中血清VEGF的表达水平降低(t=2.37,P＜0.05),放疗有效率为71.88％;未服药组患者放疗中、后血清VEGF的表达水平差异无统计学意义(t=0.18,P＞0.05),服药组与未服药组的患者比较,头晕、倦怠反应的发生率分别为62.50％和15.69％(x2=19.28,P=0.000),嗜睡的发生率分别为18.75％和1.96％(x2=5.168,P=0.023),Ⅲ-Ⅳ度食管炎发生率分别为12.50％和11.76％(x2=0.061,P=0.806),Ⅲ-Ⅳ度白细胞下降发生率分别为6.25％和9.80％(x2=0.026,P=0.872),Ⅲ～Ⅳ度血小板下降发生率分别为3.13％和5.88％(x2=0.002,P=0.965),Ⅲ～Ⅳ度恶心呕吐发生率分别为9.38％和27.45％(x2=2.913,P=0.088),过敏反应的发生率均为0.结论 沙利度胺能够降低食管癌患者血清VEGF的表达水平,患者服用沙利度胺后耐受性较好.     

食管癌放射治疗前后钡餐造影的比较

<正> 钡餐造影可以准确地显示食管癌的病变部位、范围及程度,并可进行放射治疗前后的疗效观察。现将我院自2004～2010年有完整资料的77例食管癌放疗前后的X线表现报道如下。1 资料与方法1.1 一般资料 77例患者中,男53例,女24例;最大年龄75岁,最小42岁。临床表现:均有不同程度的吞咽困难,大部分患者有胸骨后钝痛及消瘦症状。放疗前经X线及病理诊断为食管癌,其中鳞癌     

甘氨双唑钠对食管癌放疗增敏作用的临床观察

目的探讨单纯适形放疗与适形放疗联合希美钠（cMNa）治疗食管癌的疗效。方法81例食管癌患者随机分为单纯放疗组（对照组）与放疗加希美钠组（治疗组）。放疗剂量均为DT66Gy／30次,5次／周,治疗组加用希美钠800mg／m2。滴注,每周3次,隔天静脉滴注,30min滴完。结果对照组：CR24.3％,PR65．8％,总有效率90．1％。治疗组：CR60．0％,PR37．5％,总有效率97．5％,两组CR比较疗效有显著差异（P〈0．05）,总有效率比较疗效无显著差异（P〉0．05）。结论两组治疗方式对食管癌疗效无显著差异,但使用甘氨双唑钠组CR率更高。     

覆膜支架置入和/或放疗治疗中晚期食管癌

目的　评价支架置入或放疗以及二者联合应用在中晚期食管癌治疗中的作用。方法　将 2 30例患者分为三组 :先放疗后支架置入组 ,单纯支架置入组和支架置入后放疗组。随访观察比较各组疗效、不良反应、并发症及生存率。结果　放疗改善梗阻症状较慢但副反应轻 ,出现并发症再置入支架的难度大于单纯支架置入组 ,疼痛增加且较重 ,但生存期长于另外两组。单纯支架置入组患者在 1～ 3d内症状缓解 ,生存期短于另外两组。支架置入后再放疗的患者并发症较多且重 ,放疗计划完成困难 ,生存期介于另外两组之间。结论　中晚期食管癌宜先行放疗 ,酌情行支架置入既可延长生存期又可缓解症状。支架置入后再行放疗虽然可以延长患者生存期 ,但放疗反应重。单纯支架置入仅能缓解症状 ,6个月后复发率增加     

食管癌患者放疗前后血清TSGF检测的临床价值

目的：探讨血清肿瘤特异性生长因子（TSGF）含量检测在食管癌诊治中的临床价值。方法：采用透射比浊法检测94例食管癌患者和30例正常人血清TSGF含量,并对部分患者放疗前后的血清TSGF含量进行动态观察。结果：食管癌患者血清TSGF含量明显高于正常人（P〈0.05）;患者血清TSGF含量与临床分期无明显相关性;患者放疗后血清TSGF含量明显低于放疗前（P〈0.05）。结论：血清TSGF含量检测在食管癌的诊断及疗效观察中具有一定的临床价值。     

放射治疗并口服化学药物治疗食管癌疗效观察

目的探讨食管癌放射治疗同步口服化学抗癌药物治疗的作用效果。方法采用放射治疗加口服红豆衫胶囊治疗食管癌患者50例(联合组)与单纯放疗50例(单放组)进行临床疗效观察比较。结果观察病例随访3年,比较两组1、2、3年生存率,联合组分别为76%(3850)、68%(3450)和58%(2950),单放组分别为56%(2850)、44%(2250)和38%(1950),联合组高于单放组,两组间比较有统计学意义(P<005)。临床症状改善情况,联合组好于单放组。结论放射治疗与口服红豆杉胶囊同步治疗食管癌,不增加放、化疗副反应,能提高患者肿瘤消退率和近期生存率。     

Salvage radiotherapy in patients with recurrent esophageal carcinoma

Purpose

The feasibility and effectiveness of radiotherapy in the management of recurrent esophageal carcinoma (REC) is reported.

Patients and methods

A consecutive cohort of 54?patients with rcT1-4, rcN0-1, or cM0 recurrent esophageal carcinoma (69% squamous cell carcinoma, 31% adenocarcinoma) was treated between 1988 and 2010. The initial treatment for these patients was definitive radiochemotherapy, surgery alone, or neoadjuvant radiochemotherapy?+?surgical resection in 8 (15%), 33 (61%), and 13 (24%) patients, respectively. The median time to recurrence from initial treatment was 19?months (range 4?C79?months). The site of the recurrence was anastomotic or local, nodal, or both in 63%, 30%, and 7% of patients, respectively. Salvage radio(chemo)therapy was carried out with a median dose of 45?Gy (range 30?C68?Gy).

Results

Median follow-up time for surviving patients from the start of R(C)T was 38?months (range 10?C105?months). Relief of symptoms was achieved in 19 of 28 symptomatic patients (68%). The median survival time was 12?months (95%?confidence interval (CI) 7?C17?months) and the median recurrence-free interval was 8?months (95%?CI 4?C12?months). The survival rates at 1, 2, and 3?years were 55?±?7%, 29?±?6%, and 19?±?5%, respectively. The recurrence-free survival rates at 1, 2, and 3?years were 44?±?7%, 22?±?6%, and 15?±?5%, respectively. A radiation dose ???45?Gy and conformal RT were associated with a better prognosis.

Conclusion

RT is feasible and effective in the management of recurrent esophageal carcinoma, especially for relief of symptoms. Toxicity is in an acceptable range. The outcome of REC is poor; however, long-term survival of patients with recurrent esophageal carcinoma after radiochemotherpy might be possible, even with a previous history of radiotherapy in the initial treatment. If re-irradiation of esophageal carcinoma is contemplated, three-dimensional conformal techniques and a minimum total dose of 45?Gy are recommended.     

食管癌患者放疗前后血清血管内皮生长因子变化的临床意义

目的 检测食管癌患者放疗前、中、后血清血管内皮生长因子(VEGF)的水平,探讨其变化及临床意义。方法 采集67例食管癌患者和30例健康体检者(健康对照组)血清,应用酶联免疫吸附法(ELISA)测定VEGF水平,并对其变化与临床分期和患者放疗疗效的关系进行分析。结果 食管癌患者放疗前、中、后血清VEGF水平均较健康对照组升高,差异有统计学意义(F=11.65,P＜0.01);放疗后较放疗前VEGF水平明显降低,差异有统计学意义(F=10.72,P＜0.01)。T₃、T₄患者的平均VEGF水平与健康对照组比较显著升高,差异有统计学意义(F=14.10,P＜0.01)。N₁、N₂组患者的平均VEGF水平显著高于健康对照组,差异具有统计学意义(F=8.64,P＜0.01)。可评价疗效的62例患者中,有21例放疗后血清VEGF水平较放疗前升高,有41例较放疗前降低,升高组的放疗有效率为61.90%,降低组的放疗有效率为90.24%,两组比较差异有统计学意义(χ²=6.08,P＜0.05)。50例CR+PR患者放疗后及放疗中的血清VEGF水平均比放疗前显著降低,差异有统计学意义(F=7.98,P＜0.01)。结论 监测食管癌患者血清VEGF水平变化可判断患者放射治疗的敏感性,对临床预测放射治疗的预后有重要的意义。     

Ⅱ、Ⅲ期宫颈癌放疗效果与血红蛋白浓度的关系（附113例分析）

目的：探讨Ⅱ、Ⅲ期宫颈癌放疗后近期、远期疗效的关系。方法：2005～2007年113例Ⅱ、Ⅲ宫颈癌患者接受根治性放疗,放疗前及放疗中检测患者血红蛋白浓度,观察Hb和CR、无病生存的关系。结果：放疗中持续性贫血对Ⅱ、Ⅲ期宫颈癌的局部控制率及远期疗效有明显影响。结论：纠正贫血有助于宫颈癌的局部控制及提高远期疗效。     

68例食管癌三维适形放射治疗疗效观察

目的 探讨三维适形放射治疗(3D-CRT)食管癌的疗效.方法 采用3D-CRT治疗食管癌68例,常规分割2Gy/次,5次/周,总剂60～70Gy,6～7周.结果 1、3年局部控制率分别为80.9%和47.1%,1、3年生存率分别为76.4%和44.1%.毒副反应轻.结论 三维适形放射治疗食管癌能提高局部控制率和生存率,近期反应和远期反应均可耐受.     

覆膜食管支架治疗食管癌放疗后并发食管狭窄及食管瘘的临床效果

 目的 评价覆膜食管支架治疗食管癌放疗后并发食管狭窄或食管瘘的临床效果。方法 回顾性分析58例食管癌放疗后并发食管狭窄及食管瘘的患者,所有患者均在X线监视下放置Z形全覆膜食管支架,分析支架置入的疗效及安全性。结果 58例食管支架均放置成功,术后患者进食恢复通畅、瘘口封闭,各种临床症状得到有效迅速缓解,放置成功率及治疗有效率均为100.0%。术后出现胸痛52例(89.7%),恶心呕吐31例(53.4%),轻度消化道出血21例(36.2%),前两项经对症处理后可有效控制,后者自行好转。结论 采用覆膜食管支架治疗食管癌放疗后并发的食管狭窄及食管瘘简便、安全、疗效确切,值得推广。     

Self-expandable metallic stent placement for patients with inoperable esophageal carcinoma: investigation of the influence of prior radiotherapy and chemotherapy

Purpose The aim of this study was to evaluate the efficacy and complications of self-expandable metallic stent placement for patients with inoperable esophageal carcinoma after radiotherapy and/or chemotherapy. Materials and methods We obtained data from 19 patients with advanced or recurrent esophageal carcinoma between 1996 and 2000. In all patients, a self-expandable metallic stent was placed under fluoroscopic guidance. Dysphagia before and after stent placement was graded. Complications after stent placement were also evaluated. Data were compared between patients with and without prior radiotherapy and/or chemotherapy. Results The procedure was technically successful in all but one patient. The dysphagia grade improved in all patients. No life-threatening complications occurred. The other major complications such as mediastinitis occurred in two patients, and pneumonia and funnel phenomenon occurred in one patient each. These patients had a history of radiotherapy and/or chemotherapy prior to stent placement. Eight of the twelve patients with prior radiotherapy and/or chemotherapy compared with one of seven patients without prior therapy had persistent chest pain, which was a statistically significant difference (P < 0.05). Conclusion Placement of self-expandable metallic stents was effective for patients with advanced or recurrent esophageal carcinoma. However, prior irradiation and/or chemotherapy increased the risk of persistent chest pain after stent placement.     

低强度He-Ne激光血管内照射配合放疗治疗鼻咽癌的临床研究

目的探讨低强度He-Ne激光血管内照射(intravascularlowlevellaserirradiation,ILLLI)配合放疗治疗鼻咽癌的放射反应及远期疗效。方法将122例接受放疗的鼻咽癌患者随机分为单纯放疗组(对照组)和放疗+ILLLI组(治疗组),比较两组患者的急性放射反应发生率,出现急性放射反应的放疗剂量,局部复发率,远处转移率及5年生存率。结果治疗组与对照组比较,中重度急性放射反应及并发症发生率明显减少(P<0.01),出现急性放射反应的剂量明显提高(P<0.01),局部复发率,远处转移率及5年生存率两组差异无显著意义(P>0.05)。结论ILLLI可提高鼻咽癌患者放疗耐受性,降低急性放射反应及并发症发生率,不增加远处转移,可作为鼻咽癌患者放疗的有效辅助治疗措施。     

Esophageal pseudodiverticulum following high-dose-rate intracavitary irradiation for esophageal cancer

Ninety-two patients with esophageal carcinoma were treated with combination therapy of external irradiation and high-dose-rate intracavitary irradiation. Four of the 92 patients developed esophageal pseudodiverticulum after radiotherapy. Histologically, all four patients showed squamous cell carcinoma before radiotherapy and were locally controlled by the combination therapy. In three of the four cases, pseudodiverticulum was found over one year after radiotherapy. In two of these three cases, pseudodiverticulum correlated with balloon dilatation performed for benign stricture. The pseudodiverticulum of the other case was found at the end of radiotherapy and was thought to be a traction diverticulum. None of the four patients developed a fistula. As of this writing, one of them has been alive and well for 50 months since the initiation of radio-therapy. Two of the other three died due to metastasis 18 months and 27 months later. The last one died due to intercurrent disease 39 months later.