三维适形放疗结合奥沙利铂为主的化疗治疗晚期直肠癌

目的 探讨三维适形放疗（3DCRT）结合奥沙利铂为主化疗治疗局部晚期和术后复发直肠癌的临床疗效。方法 66例局部晚期和术后复发直肠癌均在常规放疗44Gy后进入3DCRT，采用3DCRT结合奥沙利铂、氟尿嘧啶、亚叶酸钙同步化疗（综合组）34例，单独应用3DCRT（对照组）32例。综合组同步放化疗结束3～4周后，再巩固化疗2～3个周期。结果 综合组和对照组疼痛缓解率分别为97％和84％（P〉0．05）；有效率（CR＋PR）分别为91％和84％（P〉0．05）；2年局部控制率与局部无进展率之和分别为71％和66％（P〉0．05）；2年生存率分别为65％和38％（P〈0．01）；2年远处转移率分别为35％和63％（P〈0．01）。在毒副反应方面两个组相似（P〉0．05）。结论 三维适形放疗结合奥沙利铂为主化疗治疗局部晚期和术后复发直肠癌可明显减少远处转移率和提高2年生存率，且毒副反应可以耐受。     

三维适形放疗联合动脉灌注化疗治疗局部晚期胰腺癌的临床疗效观察

目的 评价三维适形放射治疗结合动脉灌注化疗局部晚期胰腺癌的疗效.方法 59例局部晚期胰腺癌患者,其中33例采用三维适形放射治疗结合动脉灌注化疗(综合治疗组),26例单纯放疗组(对照组).结果 综合治疗组和对照组临庆获益反应有效率分别为91.7%和74.1%,两者差异有统计学意义(P<0.01);综合治疗组总有效率(CR+PR)为78.8%,对照组总有效(CR+PR)为42.3%,两组差异有统计学意义(P<0.01);综合治疗组和对照组的1、2和3年生存率分别为72.2%、48.5%、9.1%和50.0%、15.4%、3.9%,2年生存率综合组优于对照组(P<0.01).结论 三维适形放射治疗结合动脉灌注化疗治疗局部晚期胰腺癌,在提高生存率、长生存期方面优于单纯放射治疗.     

三维适形放射治疗胰腺癌结合化疗疗效观察

目的:探讨三维适形放射治疗(3-dimensional conformal mdiation therapy,3DCRT)结合化疗治疗胰腺癌的疗效及影响预后的因素.方法:64例胰腺癌患者中31例单独采用3DCRT,33例3DCRT前后各使用健择加顺铂方案化疗2个疗程,观察肿瘤局部缓解率及总的1、2年生存率,并用COX回归模型分析预后因素.结果:3个月、12个月肿瘤局部缓解率分别为64.1%、39.1%.总的1、2年累积生存率分别为40.2%、6.7%,中位生存期11个月.Ⅰ、Ⅱ期与Ⅲ、Ⅳ期患者1、2年生存率分别为100%、36.4%和27.4%、0(P=0.0 001),单独3DCRT组1、2年生存率为28.2%、4.0%,3DCRT结合化疗组为51.5%、9.1%(P=0.0 416).多因素分析结果显示肿瘤直径、3DCRT结合化疗对患者生存率的影响有统计学意义(P＜0.05).结论:3DCRT结合化疗是影响胰腺癌患者预后的主要因素.     

三维适形放射治疗同步泰素治疗晚期食管癌

[目的]探讨局部晚期及术后复发性食管癌三维适形放射治疗（3DCRT）同步泰素化疗的临床疗效。[方法]36例局部晚期和术后复发性食管癌采用3DCRT结合泰素化疗（综合组）17例，单独应用3DCRT（对照组）19例。[结果]综合组和对照组疼痛缓解率分别为88.2％和78．9％，有效（CR＋PR）率分别为88．2％和84.2％，两组均无显著性差异（P〉0．05）。综合组1年、2年生存率分别为87．5％、62．5％．高于对照组（79％、28．7％）．但无显著性差异（P=-0．056），2年局部控制率分别为35．29％和21．05％．无显著性差异（P=0．06）。远处转移率分别为35．2％和63．1％，有显著性差异（P=0．045）。毒副反应方面两组相似（P〉0．05）。[结论]局部晚期和术后复发性食管癌临床上行三维适形放射治疗配合化疗可明显降低远处转移率及提高患者的近期生存率。     

原发性肝癌介入治疗加三维适形放射治疗的疗效

目的 探讨肝动脉化疗栓塞（TACE）后采用三维适形放射治疗（3-DCRT）原发性肝癌的疗效。方法 50例肝癌中25例TACE＋3DCRT（综合组）,25例单纯TACE（对照组）。2个组均行TACE 1～3次,3-DCRT 采用6/15MVX线,3Gy/次，1次/天，总剂量45～54Gy。结果综合组近期有效率（CR＋PR）为84.0%,对照组为56.0%（χ^2=4.67,P〈0.05）。其中1、2年生存率综合组和对照组分别为76.0%、56.0%和48.0%、24.0%（χ^2=4.16、5.33,P〈0.05）。结论 TACE＋3DCRT是治疗不宜手术的原发性肝癌的较好方法。     

三维适形放疗联合动脉化疗胰头癌疗效观察

目的:提高局部晚期胰头癌的治疗效果。方法:44例Ⅱ、Ⅲ期胰头癌,采用三维适形放疗(3DCRT)结合腹腔动脉干灌注化疗(治疗组)24例,单独应用3DCRT(对照组)20例。结果:疼痛缓解率治疗组和对照组分别为75%和80%。两组1、2年生存率分别为70.8%、50%和50%、15%,2年生存率治疗组优于对照组(P<0.05)。结论:对不能切除的胰头癌,行3DCRT区域性动脉化疗结合,是治疗局部晚期胰头癌的一种有效方法。     

适形放射治疗结合介入治疗不宜手术的原发性肝癌

目的：探讨肝动脉化疗栓塞（TACE）后采用三维适形放射治疗（3DCRT）原发性肝癌的疗效。方法：82例肝癌中41例TACE＋3DCRT（综合组），41例单纯TACE（对照组）。TACE先将氟尿嘧啶1000－1250mg和羟基喜树碱20－30mg注入动脉，再将顺铂60－80mg和丝裂霉14－20mg(或表阿霉素50－60mg)与超液化碘油10－30ml充分混合成乳剂注入，再用1－2mm明胶海绵颗粒栓塞肝动脉。2个组TACE均进行1－3次，3DCRT6采用6MV X射线，计划靶体积（PTV）≤216cm^3者单次剂量为5－8Gy，总剂量为DT40－56Gy；PTV＞216cm^3者单次剂量为4Gy，总剂量36－44Gy；二者均隔日1次，结果：综合组近期有效率（CR＋PR）为87．8％，对照组为58．5％，两组差异有显著性意义（X^2=8．94，P＜0．01）。1、2、3年生存率综合组分别为73．2％，58．7％和41．9％，对照组分别为54．8％，27．3％和12．8％，两组差异有显著性意义（X^2＝5．52，P＜0．05），综合组3DCRT前PTV≤216cm^3者与PTV＞216cm^3者相比，前者3年生存率大于后者（53．8％；20．0％；X^2＝4．72，P＜0．05）。肝功能A级和B级3年生存率分别为56．3％和14．3％，差异有显著性意义（X^2＝5．49，P＜0．05）。结论：TACE＋3DCRT治疗不宜手术的原发性肝癌疗效较好。     

三维适形放射治疗联合羟基喜树碱治疗局部晚期非小细胞肺癌疗效分析

 目的 评价三维适形放射治疗（3DCRT）联合羟基喜树碱（HCPT）治疗局部晚期非小细胞肺癌NSCLC的价值。方法 95例患者随机分为治疗组和对照组，治疗组采用3DCRT加HCPT全身化疗，对照组单用3DCRT。结果 治疗组和对照组近期疗效（CR+PR）分别为73.4 %，62 %（P <0.001）。1、2年生存率分别为65 %，26 %和54 %，22 %（P <0.01），差异具有统计学意义。结论 3DCRT可以提高肿瘤局部剂量和局控率，HCPT使放疗增敏，二者结合，是有效治疗NSCLC的方法。     

GP方案区域化疗与静脉化疗治疗进展期胰腺癌疗效的对比研究

目的:对比分析采用GP方案胰腺区域性动脉灌注与静脉化疗治疗晚期胰腺癌的临床疗效。方法:采用随机法将68例晚期胰腺癌分为胰腺区域性动脉灌注组36例和静脉化疗组32例,平均化疗2.5个周期。结果:胰腺区域性动脉灌注组有效率为25.0%,中位疾病进展时间为9个月,临床获益率为50.0%,中位生存期为12个月,6个月生存率为55.6%,9个月生存率为25.0%;静脉化疗组有效率为12.5%,中位进展时间为3个月,中位生存期为5.5个月,临床获益率为25.0%,6个月生存率为31.2%,9个月生存率为18.7%。胰腺区域性动脉灌注组有效率、临床获益率、中位进展时间、中位生存期及生存率均高于静脉化疗组,差异有统计学意义,P<0.05。胰腺区域性动脉灌注组白细胞及血小板减少发生率分别为27.8%和25.0%,静脉化疗组分别为71.9%和56.3%。两组比较差异均有统计学意义,χ2值分别为13.189和6.911,P值分别为0.000和0.009。结论:GP方案胰腺区域性动脉灌注是治疗进展期胰腺癌的有效方案,且毒副反应可耐受。     

三维适形放射配合化疗治疗局部晚期和术后复发性直肠癌

目的　探讨局部晚期和术后复发性直肠癌三维适形放射治疗 (3DCRT)配合化疗的临床疗效。方法　 2 4例局部晚期和术后复发性直肠癌均在外照射 4 4Gy后进入 3DCRT ,采用 3DCRT结合氟尿嘧啶为主型同步化疗 (综合组 ) 11例 ,单独应用 3DCRT(对照组 ) 13例。结果　综合组和对照组疼痛缓解率分别为 90 .9%和 84 .6 % ,有效 (CR PR)率分别为 90 .9%和 6 9.2 % ,2个组差异均无显著性意义 (P值均 >0 .0 5 )。 2个组 2年生存率分别为 6 3.6 %、38.5 % ,生存率比较综合组优于对照组 (χ2 =6 .12 ,P =0 .0 13) ;2年局部控制率分别为 72 .7%、6 1.5 % ,差异无显著性意义 (χ2 =3.74 ,P =0 .0 5 3) ;远地转移率分别为 36 .3%、6 1.5 % ,差异有极显著性意义 (χ2 =7.39,P =0 .0 0 7)。在毒副反应方面 2个组相似 (P >0 .0 5 )。结论　局部晚期和术后复发性直肠癌临床行外放射 三维适形放射治疗配合化疗可明显减少远地转移率和提高患者的近期生存率。     

七例胰腺实性假乳头状瘤的诊治分析

目的探讨胰腺实性假乳头状瘤（SPTP）的诊断、治疗和预后。方法回顾性分析2002年1月至2008年12月经手术治疗7例实性假乳头状瘤的临床资料。结果7例均获得手术切除,其中胰十二指肠切除术1例,胰体尾联合脾切除术2例,胰体尾切除1例,肿瘤局部切除3例,1例术后20d随访,余6例术后随访6～82个月,均未出现复发和转移。结论SPTP多见于年轻女性,无特异性临床表现。CT是重要的诊断方法。SPT的恶性程度较低,以手术切除为主,完整切除后预后良好。     

三维适形放射治疗晚期胰腺癌近期疗效分析

目的评估晚期胰腺癌三维适形放射治疗的近期疗效。方法38例Ⅲ、Ⅳ期胰腺癌患者采用电动多叶光栅和三维治疗计划系统进行肿瘤局部适形放疗。结果全部38例患者经适形放疗后症状均得到缓解,缓解率90.6%;根据WHO实体瘤疗效评价标准,近期总有效率86.8%。结论对于晚期胰腺癌,三维适形放疗的近期疗效显著,是缓解患者症状、使肿瘤局部控制的有效治疗方法。     

胰腺癌术中放射治疗的价值

目的：回顾总结诸多放射治疗方式对胰腺癌治疗的价值。方法：1986－1999年间收治的无法手术切除的晚期胰腺癌患者68例，伴有严理和中度腹背痛的65例作为研究对象，其中无腹背痛的3例除外，单纯接受术中放射治疗25例，术中放射治疗加体外放射治疗20例，单纯体外放射治疗20例，另外单纯手术治疗胰腺癌30例作对照。结果：（1）单纯术中放射治疗组患者背痛和腹痛的完全缓解率为47％，部分缓解率为34％，总疼痛缓解率为81％，术后2周内见效，中位生存期为5．9个月（从治疗开始计算）。（2）术中放射治疗加体外放射治疗组患者背痛和腹痛的缓解率同单纯疗后4周左右见效，中位生存期是4．5个月。（4）单纯手术治疗组中位生期7个月。结论：术中放射治疗加体外放射治疗能明显延长晚期胰腺癌患者的生存期，而且能明显缓解患者的疼痛，见效快，提高了患者的生活质量。     

胃癌调强放疗后胰腺亚临床功能损伤评估与保护

目的:通过相关生化指标和胰腺体积改变来评估胃癌调强放疗(IMRT)后胰腺亚临床功能损伤,并探讨通过剂量学预测以及剂量限制来降低胰腺剂量。方法:回顾性选择接受45 Gy术后辅助放化疗且无胰腺基础疾病的胃癌患者30例,勾画胰腺并评估剂量及与计划靶体积(PTV)解剖位置关系。分析放疗前后患者空腹血糖、血清脂肪酶和血清淀粉酶以...     

Carcinoma of the pancreas: results of irradiation for unresectable lesions

From 1973 to 1977, 20 patients who had histologically proven unresectable adenocarcinoma of the pancreas with no distant metastases were irradiated at the Medical College of Wisconsin Affiliated Hospitals. The patients received megavoltage external irradiation to minimum tumor doses ranging between 3000 rod in 4 weeks and 5700 rod in 7 weeks (median 4600 rod in 6 weeks their actuarial survival was 54% at 12 months and 21% at 24 months.Fourteen patients who received 4500 rod or more in 6–7 weeks had a median survival of 13 months. Six patients received less than 4500 rod in 3–6 weeks, and their median survival was 7 months. At this writing, three patients are alive and apparently disease free more than 2 years after treatment.Complications were seen in two patients. One died from GI bleeding 2 months after completion of radiation therapy, and the other patient developed pancreatic insufficiency.These results and recent reports in the literature show that aggressive irradiation can result in long-term disease free survival in a small proportion of patients with unresectable pancreatic adenocarcinoma. Further exploitation of this approach alone or combined with chemotherapy is warranted.     

Chemoradiotherapy for unresectable pancreatic cancer

Treatment options for unresectable pancreatic cancer, including concurrent chemoradiotherapy, chemotherapy alone, and chemotherapy followed by chemoradiotherapy, are largely ineffective and result in a median survival of approximately 10–12 months. Although quality data on the benefit of radiotherapy in unresectable pancreatic cancer are lacking, it seems unlikely that the low-efficacy chemotherapy used for pancreatic cancer would control gross disease. Current regimens deliver low, ineffective doses of radiation and are associated with high rates of local failure. New technological advances, such as intensity-modulated radiotherapy, now allow the safe delivery of high-dose, highly conformal radiotherapy concurrently with full systemic doses of chemotherapy. We review new knowledge related to pattern of failure, target definition, and target motion and discuss the implications of these data on modern radiotherapy treatment planning and delivery. While it is clear that breakthroughs in treatment would come mostly from advances in systemic therapy, the evidence suggests that radiotherapy should not fall out of use, but rather be intensified.     

Primary sarcomas of the pancreas: A review of 253 patients from the National Cancer Data Base

Introduction

Primary sarcomas of the pancreas are rare, and the limited data regarding their presentation, oncologic profile, and survival have been derived from small case series.

Age as a prognostic indicator for adjuvant therapy in patients who underwent pancreatic resections for cancer

Purpose

In pancreatic cancer, the greatest increase in survival is attained by surgical resection followed by adjuvant chemotherapy. Although surgical complications and functional status are recognized as independent factors for halting adjuvant therapy in patients that undergo pancreatic resections, other elements may play a role in deciding which patients get treated postoperatively. Here we determined demographic and clinical characteristics of patients receiving adjuvant chemotherapy, with the primary intent to investigate if age alone affects rates of adjuvant therapy.

Pancreatic cancer,autoimmune or chronic pancreatitis,beyond tissue diagnosis: Collateral imaging and clinical characteristics may differentiate them

Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal malignancies and is developing into the 2^nd leading cause of cancer-related death. Often, the clinical and radiological presentation of PDAC may be mirrored by other inflammatory pancreatic masses, such as autoimmune pancreatitis (AIP) and mass-forming chronic pancreatitis (MFCP), making its diagnosis challenging. Differentiating AIP and MFCP from PDAC is vital due to significant therapeutic and prognostic implications. Current diagnostic criteria and tools allow the precise differentiation of benign from malignant masses; however, the diagnostic accuracy is imperfect. Major pancreatic resections have been performed in AIP cases under initial suspicion of PDAC after a diagnostic approach failed to provide an accurate diagnosis. It is not unusual that after a thorough diagnostic evaluation, the clinician is confronted with a pancreatic mass with uncertain diagnosis. In those cases, a re-evaluation must be entertained, preferably by an experienced multispecialty team including radiologists, pathologists, gastroenterologists, and surgeons, looking for disease-specific clinical, imaging, and histological hallmarks or collateral evidence that could favor a specific diagnosis. Our aim is to describe current diagnostic limitations that hinder our ability to reach an accurate diagnosis among AIP, PDAC, and MFCP and to highlight those disease-specific clinical, radiological, serological, and histological characteristics that could support the presence of any of these three disorders when facing a pancreatic mass with uncertain diagnosis after an initial diagnostic approach has been unsuccessful.     

3.0T MR动态增强技术对胰腺肿瘤非病变区域的半定量分析研究

目的对正常胰腺、胰腺癌及胰腺良性肿瘤患者的3.0T MR快速三维动态增强扫描序列进行半定量分析,为临床提供胰腺肿瘤非病变区域的灌注特点及判断潜在病变的半定量指标。方法对40例非胰腺疾病患者(对照组)、43例经病理证实的胰腺癌患者(胰腺癌组)、26例胰腺良性肿瘤患者(胰腺良性肿瘤组)行全胰腺T1权重LA-VA 9期动态增强扫描,将所得数据传至ADW 4.2工作站处理,分别测量对照组胰腺的头、体、尾的30s强化率(SER30)、90s强化率(SER90)、达峰时间(TTP)、正增强积分(PEI)、最大强化斜率(MSI),胰腺癌组及胰腺良性肿瘤组的非病变区域的SER30、SER90、TTP,对所得数据进行统计学分析。结果对照组胰腺头、体、尾的SER30、SER90、PEI、TTP及MSI差异无统计学意义(P0.05)。胰腺良性肿瘤组非病变区域与对照组任意区域的各项参数差异均无统计学意义(P0.05);胰腺癌组非病变区与对照组任意区域及胰腺良性肿瘤组非病变区的SER90及TTP均有显著性差异(P0.05)。结论正常胰腺的不同部位间无灌注差异;胰腺癌的非病变区域存在潜在病变浸润。