三乙醇胺乳膏防治急性放射性皮炎的疗效观察

目的：观察三乙醇胺乳膏预防急性放射性皮炎的临床效果。方法：将放射治疗的86例鼻咽癌和乳腺癌根治术或改良根治术后需行辅助性放射治疗的病人随机分为用药组（45例）和对照组（41例）。用药组在放射治疗开始即给予三乙醇胺乳膏涂擦,直至放疗结束,发生湿性皮炎后局部继续涂擦三乙醇胺乳膏;对照组保持照射野皮肤干燥、清洁,不予任何药物外涂,发生湿性皮炎后局部涂擦烫伤油。结果：用药组Ⅱ级及以上急性放射性皮炎的发生率明显低于对照组（ P＜0.05）,存在统计学差异。对照组有1例发生Ⅳ级急性放射性皮炎,而用药组无Ⅳ级急性放射性皮炎发生。且用药组急性放射性皮炎发生时间明显晚于对照组,差异有统计学意义（P＜0.05）。同时用药组明显缩短急性放射性皮炎愈合时间（P＜0.05）。结论：三乙醇胺乳膏能有效地防治急性放射性皮炎。     

三乙醇胺治疗乳腺癌术后放射性皮炎

目的:观察三乙醇胺乳膏在治疗乳腺癌根治术后放疗导致的皮肤损伤的效果。方法:收集2015年1月至2017年12月的296例乳腺癌根治术后患者。观察组159例:IGRT放疗+外用三乙醇胺乳膏，三乙醇胺乳膏从放疗第一天开始使用，至放疗结束后一周。对照组137例:单纯行IGRT放疗。结果:使用了乳膏的患者发生放射性皮炎的时间明显延迟。33.96%（54/159）的患者在放疗第三周开始后发生放射性皮炎，而未使用乳膏的患者为21.90%(30/137)。从放疗第二、三、四、五周观察统计可见，使用乳膏后，发生放射性皮炎的严重程度也明显减轻，未使用乳膏的患者发生Ⅲ-Ⅳ级放射性皮炎的几率明显高于观察组。在放疗期间因放射性皮肤损伤导致放疗中断，观察组有1例，对照组6例，两组有统计学差异（P<0.05）。在放疗结束后恢复阶段，使用了乳膏的患者恢复明显较对照组快，差异有显著统计学意义（P<0.01）。结论:三乙醇胺乳膏可有效减轻放射性皮炎发生的严重程度，可有效延缓放射性皮炎发生的时间，可减少因放射性皮炎引起的非计划性放疗中断发生率，可加快放射性皮炎的恢复速度，增加患者放疗的依从性，减少因治疗给患者带来的痛苦，值得临床推广应用。     

三乙醇胺乳膏防治急性放射性皮炎的疗效观察及其影响因素分析

目的观察三乙醇胺乳膏（trolamine cream）在预防和治疗鼻咽癌患者急性放射性皮炎中的作用以及发生急性放射性皮炎的影响因素。方法 2008年1月至2010年9月收治的271例鼻咽癌患者,按照是否应用三乙醇胺乳膏分为用药组138例和对照组133例。两组均行同步放化疗。结果用药组出现1级放射性皮炎56例,2级70例,3级12例,对照组分别为34、76和23例,两组比较差异有统计学意义（P〈0.05）。出现2级皮肤反应的照射剂量用药组与对照组比较差异有统计学意义（Z=-7.558,P=0.000）,用药组明显高于对照组,出现3级皮肤反应的照射剂量用药组与对照组比较差异无统计学意义。用药组出现2级放射性皮炎的发生率显著高于对照组（Log Rank=29.061,P=0.000）。影响出现2级以上放射性皮炎的因素为是否用药和是否同步放化疗。结论在放疗早期使用三乙醇胺乳膏不仅可以提高皮肤对急性放射性损伤的耐受性,延缓皮肤反应出现时间,还可以减轻皮肤损伤的程度。同期放化疗增加了急性放射性皮肤损伤发生的危险性。     

放射性皮炎预防与治疗研究进展

放射性皮炎是肿瘤患者放疗过程中最常见的并发症之一,其发生率及严重程度与治疗相关因素及患者自身危险因素等有关。放射性皮炎可影响患者生活质量,严重者甚至导致治疗中断,进而使肿瘤控制率下降。目前评估急性放射性皮炎的预防措施的随机对照研究很少,临床处理存在很大差异。本文针对放射性皮炎的发病机制、危险因素、临床表现、评估、预防和治疗进行探讨。     

鼻咽癌急性放射性皮炎的研究进展

急性放射性皮炎是鼻咽癌放疗患者最常见的不良反应之一,主要表现为红斑、脱屑和溃疡等,严重影响患者的生活质量,目前无公认的标准防治方法。本文主要就鼻咽癌急性放射性皮炎的防治方法进行文献回顾,并提出问题及展望,为临床和科研提供一定参考。     

三乙醇胺对乳腺癌保留乳房术后同时推量照射皮肤保护作用的临床观察

目的:观察三乙醇胺乳膏在预防乳腺癌保留乳房术后同时推量调强放疗患者急性放射性皮炎中的作用.方法:选取101例2003-01-2010-03收治的早期乳腺癌保留乳房术后患者,分为预防组(52例)和对照组(49例).预防组从放疗第1天预防性应用三乙醇胺乳膏涂抹照射野皮肤并>1 cm的范围;对照组采用常规皮肤护理.结果: 预防组Ⅰ、Ⅱ和Ⅲ度急性放射性皮炎的发生率分别为90.4%(47/52)、7.7%(4/52)和1.9%(1/52),对照组分别为69.4%(34/49)、24.5%(12/49)和6.1%(3/49),P=0.030.预防组≥Ⅱ度急性放射性皮炎的发生时间为21～36 d,中位时间28 d;对照组为14～35 d,中位时间17 d,P=0.006.放疗中断预防组2例,对照组8例,P=0.047.结论: 三乙醇胺乳膏对早期乳腺癌保留乳房术后同时推量调强放疗所致的急性放射性皮炎有较好的预防效果,减轻了皮肤的急性放射性损伤,保障放疗计划顺利实施.     

三乙醇胺乳膏防治急性放射性皮炎的疗效观察及其影响因素分析

目的观察三乙醇胺乳膏(trolamine cream)在预防和治疗鼻咽癌患者急性放射性皮炎中的作用以及发生急性放射性皮炎的影响因素。方法 2008年1月至2010年9月收治的271例鼻咽癌患者,按照是否应用三乙醇胺乳膏分为用药组138例和对照组133例。两组均行同步放化疗。结果用药组出现1级放射性皮炎56例,2级70例,3级12例,对照组分别为34、76和23例,两组比较差异有统计学意义(P<0.05)。出现2级皮肤反应的照射剂量用药组与对照组比较差异有统计学意义(Z=-7.558,P=0.000),用药组明显高于对照组,出现3级皮肤反应的照射剂量用药组与对照组比较差异无统计学意义。用药组出现2级放射性皮炎的发生率显著高于对照组(Log Rank=29.061,P=0.000)。影响出现2级以上放射性皮炎的因素为是否用药和是否同步放化疗。结论在放疗早期使用三乙醇胺乳膏不仅可以提高皮肤对急性放射性损伤的耐受性,延缓皮肤反应出现时间,还可以减轻皮肤损伤的程度。同期放化疗增加了急性放射性皮肤损伤发生的危险性。     

金因肽对急性放射性黏膜炎及皮炎的作用

目的 观察金因肽（重组人表皮生长因子，rhEGF）预防和治疗急性黏膜炎和急性放射性皮炎的作用。方法 120例头颈部肿瘤患者被随机分为3个组：（1）黏膜炎预防必用药与对照组；（2）黏膜炎治疗性用药与对照组；（3）皮炎治疗性用药与对照组。用药组患者钭金因肽喷于受照射区域的皮肤或黏膜，常规处理作为对照。预防性用药及对照组的常规处理与放射治疗同期进行。治疗性用药与对照组的处置作为对照。预防性用药及对照组的常规处理与放射治疗周期进行，治疗性用药与对照组的处置待出现Ⅰ级放射性黏膜炎或皮炎后再进行，根据RTOG急性放射性黏膜炎和皮炎的分级标准进行临床评价。结果 黏膜炎预防用药与对照组比较，放射治疗剂量≤10Gy时放射性黏膜炎的发生率分别为20％（4／20）和70％（14／20）（P＝0.004）。在放射治疗中无论是预防用药组还是治疗用药组的Ⅲ、Ⅳ级急性放射性黏膜炎及皮炎的发生率均低于相应对照组。金因肽治疗急性放射性黏膜炎及皮炎与对照组比较期有效率分别为90％（18／20）对50％（10／20）（P＝0.016）和95％（19／20）对50％（10／20）（P＝0.005），且Ⅲ级放射性皮炎愈合时间≤3d在用药组有3／7，而对照组为0／14。预防性用金因肽可推迟放射性黏膜的发生，预防用药组及治疗用药组金因肽均可降低Ⅲ、Ⅳ级黏膜炎和皮炎的发生率，并可促进Ⅲ级皮炎的愈合。     

三乙醇胺防治鼻咽癌放射性皮肤损伤的临床观察

目的：观察三乙醇胺乳膏预防和治疗鼻咽癌患者急性放射性皮肤损伤的临床疗效。方法：将61例接受放射治疗的鼻咽癌患者随机分为2组,31例在放疗开始时给予三乙醇胺乳膏涂抹为用药组,30例只进行常规皮肤护理指导为对照组。结果：用药组出现皮肤反应较慢,在照射剂量40Gy以前,对照组80.0%出现皮肤反应,而用药组仅有38.7%出现皮肤反应（P〈0.05）。用药组2级放射性皮肤反应发生率为29.1%,未出现3级以上放射性皮肤反应,而对照组2级以上放射性皮肤反应达83.4%,其中3级为6.7%,4级为6.7%（P〈0.05）。结论：三乙醇胺乳膏能有效减轻和预防放射性皮炎的发生,保证放射治疗的顺利进行。     

芦荟联合重组人表皮生长因子防治鼻咽癌急性放射性皮炎的疗效观察

目的:探讨芦荟联合重组人表皮生长因子对鼻咽癌患者急性放射性皮炎的防治效果。方法:选取100例根治性放疗的鼻咽癌患者,随机分为两组。50例患者第1次放疗后涂抹重组人表皮生长因子及芦荟汁为实验组,50例仅涂抹芦荟汁为对照组。结果:实验组和对照组急性放射性皮炎发生率分别为48.0％、84.0％（P＜0.01）。I-Ⅱ级放射性皮炎发生率实验组为42.0%（21/50）,对照组为66.0%（33/50）。 Ⅲ-Ⅳ级放射性皮炎发生率实验组为6.0％(3／50),对照组为18.0％(9/50)。实验组疼痛评分较对照组低（P＜0.01）。放疗结束后随访4周,实验组患者91.7%（22/24）在1周内急性放射性皮炎病情缓解,对照组61.9%（26/42）的患者在1周内病情缓解。对照组急性放射性皮炎持续时间长于实验组（P＜0.05）。结论:芦荟联合重组人表皮生长因子防治鼻咽癌急性放射性皮炎效果良好,可减轻患者痛苦、改善生活质量,为鼻咽癌患者放疗顺利进行提供保障。     

肺癌骨转移诊治的研究进展

肺癌骨转移常严重影响患者的生活质量及生存期,因此须尽早诊断和恰当处理。骨转移的临床诊断方法包括X线平片、CT、MRI、ECT、PET等,其敏感性和特异性各有不同;新近的基因芯片技术对肿瘤微转移灶进行早期诊断,对肿瘤细胞的基因分析还有助于更好了解原发肿瘤的生物学特性及寻找有效措施早期清除微转移灶。治疗包括局部和全身治疗。外科手术主要用于预防或治疗局部压迫及骨折,放疗则为止痛的有效措施。二磷酸盐类、特别是第三代二磷酸盐类的开发,为中晚期肺癌骨转移患者的姑息治疗提供了一种方便有效的方法。此外,积极的支持对症治疗同样十分重要。     

Étude des facteurs pronostiques de radiodermite aiguë dans le cancer du sein traité par irradiation conformationnelle adjuvante avec ou sans modulation d’intensité

PurposeReal life study of prognostic factors of acute radiodermatitis in a monocentric cohort of 200 patients with breast cancer treated with RT3D or IMRT for adjuvant radiotherapy.Patients and methodsThis study comprises 200 patients with breast cancer treated with adjuvant radiotherapy, included consecutively. For each patient, their clinical and tumoral characteristics and the irradiation schedule was retrospectively collected. The severity of acute radiodermatitis was also collected, during the treatment and 6 weeks after the end of irradiation. The objective was to identify risk factors for acute radiodermatitis grade ≥ 2.ResultsThe univariate analysis found that a more important BMI (p < 0.001), a more important volume of PTV (p < 0.001) a normofractionated schedule (p = 0.002) were statistically associated to a greater risk of occurrence of grade ≥ 2 acute radiodermatitis. The multivariate analysis found BMI > 30 (OR = 9.31, p = 0.04), light phototype (OR = 0.04, p = 0.02) and histology other than invasive breast carcinomas (OR = 0.07, p = 0.04) to be statistically associated to the occurrence of grade ≥ 2 acute radiodermatitis.ConclusionIn this monocentric retrospective study, with a prospective collection of the severity of acute radiodermatitis, no grade 3 radiodermatitis has been observed and the frequency of occurrence of grade 2 radiodermatitis was lower than previously published. In contrast to previously published results, IMRT was not associated to a lower risk of grade ≥ 2 acute radiodermatitis. Multivariate analysis found BMI, phototype, and histology to be risk factors of grade ≥ 2 acute radiodermatitis.     

芳香化酶抑制剂致骨质疏松研究进展

乳腺癌患者服用芳香化酶抑制剂(AI)使得卵巢功能缺失导致体内雌激素水平下降,从而加速骨代谢发生骨质疏松.在临床中应给予重视并根据具体情况选择适当防治手段.推荐使用钙剂+维生素D、双膦酸盐、选择性雌激素受体调节剂、中药等药物治疗,减少骨质疏松的发病率.     

Significant suppression of radiation dermatitis in breast cancer patients using a topically applied adrenergic vasoconstrictor

Background

Our previous studies showed that vasoconstrictor applied topically to rat skin minutes before irradiation completely prevented radiodermatitis. Here we report on a Phase IIa study of topically applied NG12-1 vasoconstrictor to prevent radiodermatitis in post-lumpectomy breast cancer patients who received at least 40 Gray to the whole breast using standard regimens.

Methods

Patients had undergone surgery for Stage Ia, Ib, or IIa infiltrating ductal or lobular carcinoma of the breast or ductal carcinoma in situ. NG12-1 formulation was applied topically to the same 50-cm² treatment site within the radiation field 20 min before each daily radiotherapy fraction.

Results

Scores indicated significant reductions in radiodermatitis at the NG12-1 treatment site versus control areas in the same radiotherapy field. The mean dermatitis score for all subjects was 0.47 (SD 0.24) in the NG12-1-treated area versus 0.72 (SD 0.22) in the control area (P =?0.022). Analysis by two independent investigators indicated radiodermatitis reductions in 9 of the 9 patients with scorable radiodermatitis severity, and one patient with insufficient radiodermatitis to enable scoring. There were no serious adverse events from NG12-1 treatment.

Conclusions

Thirty, daily, NG12-1 treatments, topically applied minutes before radiotherapy, were well tolerated and conferred statistically significant reductions in radiodermatitis severity (P =?0.022).

Trial registration

NCT01263366; clinicaltrials.gov

     

Breast density: a biomarker to better understand and prevent breast cancer

In Quebec, cancer is the principal cause of mortality. This epidemiologic research program includes two components. The first component takes place at the "Institut national de santé publique du Québec" and involves surveillance and evaluation of practices in oncology with the aim of providing the Quebec Ministry of Health with some of the evidence needed to determine its policies in cancer control. The second component takes place at the "Unité de recherche en santé des populations (URESP)" of Laval University and is devoted to studying the etiology and prevention of breast cancer. This paper focuses on this second research component which uses mammographic breast density as an intermediate biomarker to study the causes of breast cancer and strategies to prevent it. Breast cancer risk is much higher among women with very dense breasts than among those with little or no breast density. Recently, we were among the first to show that women with high vitamin D or calcium intakes have less breast density than those with low intakes, especially among premenopausal women. Furthermore, we have confirmed that breast density was increased among premenopausal women with high levels of IGF-I and low levels of IGFBP3 which is consistent with the observed effect of these molecules on breast cancer risk. Studies are now being conducted to assess whether breast density varies according to blood levels of vitamin D and of additional growth factors, as well as to genetic polymorphisms involved in the pathways of vitamin D, calcium and growth factors. The increase in vitamin D and calcium intakes may prove to be a safe and inexpensive approach to breast cancer prevention; this possibility should be carefully examined as quickly as possible.     

How to reduce radiation-related toxicity in patients with cancer of the head and neck

Radiation for head and neck cancers is often curative, but high doses are used. Normal tissues, including mucosa, salivary glands, and muscles, are exposed to these high doses, resulting in severe mucositis, xerostomia, and dysphagia. Efforts to minimize toxicity have involved advances in radiation physics and development of pharmacologic agents. Radiation techniques include conformal and intensity-modulated therapy, which minimizes dose to normal tissues while delivering high doses to tumor targets. Drugs used to prevent mucositis have targeted infection, but recently interest has been shown in the use of growth factors. Cholinergic agonists and cytoprotective agents, specifically amifostine, can address xerostomia. Involvement of speech pathologists in evaluation and treatment of patients with dysphagia can minimize swallowing difficulties and identify the tissues most responsible for swallowing. Minimizing radiation dose to these tissues may lower the incidence of radiation-induced dysphagia.     

Vitamin D and breast cancer

In addition to its role in calcium homeostasis and bone health, vitamin D has also been reported to have anticancer activities against many cancer types, including breast cancer. The discovery that breast epithelial cells possess the same enzymatic system as the kidney, allowing local manufacture of active vitamin D from circulating precursors, makes the effect of vitamin D in breast cancer biologically plausible. Preclinical and ecologic studies have suggested a role for vitamin D in breast cancer prevention. Inverse associations have also been shown between serum 25-hydroxyvitamin D level (25(OH)D) and breast cancer development, risk for breast cancer recurrence, and mortality in women with early-stage breast cancer. Clinical trials of vitamin D supplementation, however, have yielded inconsistent results. Regardless of whether or not vitamin D helps prevent breast cancer or its recurrence, vitamin D deficiency in the U.S. population is very common, and the adverse impact on bone health, a particular concern for breast cancer survivors, makes it important to understand vitamin D physiology and to recognize and treat vitamin D deficiency. In this review, we discuss vitamin D metabolism and its mechanism of action. We summarize the current evidence of the relationship between vitamin D and breast cancer, highlight ongoing research in this area, and discuss optimal dosing of vitamin D for breast cancer prevention.     

Complications of radioactive iodine treatment of thyroid carcinoma

Radioactive iodine (RAI) in the form of (131)I has been used to treat thyroid cancer since 1946. RAI is used after thyroidectomy to ablate the residual normal thyroid remnant, as adjuvant therapy, and to treat thyroid cancer metastases. Although the benefits of using RAI in low-risk patients with thyroid cancer are debated, it is frequently used in most patients with thyroid cancer and is clearly associated with acute and long-term risks and side effects. Acute risks associated with RAI therapy include nausea and vomiting, ageusia (loss of taste), salivary gland swelling, and pain. Longer-term complications include recurrent sialoadenitis associated with xerostomia, mouth pain, dental caries, pulmonary fibrosis, nasolacrimal outflow obstruction, and second primary malignancies. This article summarizes the common complications of RAI and methods to prevent and manage these complications.     

Bone-modifying Agents (BMAs) in Breast Cancer

Bone-modifying agents (BMAs) are mainstays in breast cancer and prevent and treat osteoporosis in early-stage disease and reduce skeletal metastases complications in advanced disease. There is some evidence to support that BMA also prevents skeletal metastases and improves overall survival. Bone loss occurs with chemotherapy-induced ovarian failure, gonadotrophin-releasing hormone (GnRH) agonists, and aromatase inhibitors. In some women, the bone loss will be of sufficient magnitude to increase the risks of osteoporosis or fractures. Recommended steps in osteoporosis prevention or treatment include risk factor assessment, taking adequate amounts of calcium and vitamin D3, and periodic evaluations with dual-energy x-ray absorptiometry scanning. If clinically indicated by the T-scores and fracture-risk prediction algorithms treat with oral, IV bisphosphonates or subcutaneous denosumab (DEN). Zoledronic acid (ZA) or DEN reduces skeletal metastases complications, including pathological fracture, spinal cord compression, or the necessity for radiation or surgery to bone. Also, both of these drugs have the side-effect of osteonecrosis at a similar incidence. Monthly administration of ZA or DEN is standard, but several recent randomized trials show noninferiority between ZA monthly and every 3-month ZA. Every 3-month ZA is a new standard of care. Similar trials of the schedule of DEN are ongoing. ZA anticancer effect is only in postmenopausal women or premenopausal women rendered postmenopausal by GnRH agonists or bilateral oopherectomy. High-risk women, either postmenopausal or premenopausal, receiving GnRH/oopherctomy should consider adjuvant ZA. There are insufficient data to support DEN in this setting. Herein, this narrative review covers the mechanism of action of BMA, randomized clinical trials, and adverse events, both common and rare.     

Prévention médicale et traitement des complications pulmonaires secondaires à la radiothérapie

Radiation-induced lung injuries mainly include the (acute or sub-acute) radiation pneumonitis, the lung fibrosis and the bronchiolitis obliterans organizing pneumonia (BOOP). The present review aims at describing the diagnostic process, the current physiopathological knowledge, and the available (non dosimetric) preventive and curative treatments. Radiation-induced lung injury is a diagnosis of exclusion, since clinical, radiological, or biological pathognomonic evidences do not exist. Investigations should necessarily include a thoracic high resolution CT-scan and lung function tests with a diffusing capacity of the lung for carbon monoxide. No treatment ever really showed efficacy to prevent acute radiation-induced lung injury, or to treat radiation-induced lung fibrosis. The most promising drugs in order to prevent radiation-induced lung injury are amifostine, angiotensin-converting-enzyme inhibitors and pentoxifylline. Inhibitors of collagen synthesis are currently tested at a pre-clinical stage to limit the radiation-induced lung fibrosis. Regarding available treatments of radiation-induced pneumonitis, corticoids can be considered the cornerstone. However, no standardized program or guidelines concerning the initial dose and the gradual tapering have been scientifically established. Alternative treatments can be prescribed, based on clinical cases reporting on the efficacy of immunosuppressive drugs. Such data highlight the major role of the lung dosimetric protection in order to efficiently prevent radiation-induced lung injury.