食管癌钴60照射病理改变与临床分析

 食管癌患者术前放疗组62例，根据他们对放疗的反应，分为低效反应和有效反应，两者3年和5年生存率有显著差异（P<0.05）。术前放疗组残端未发现断端癌，单一手术组58例，其中发现断端原位癌5例（8.62%），不典型增生Ⅱ级1例（1.72%）。断端癌的发生似乎与主体癌组织分化有关，分化Ⅲ级者中发现3例（3/22）。食管癌术前放疗远期生存率的提高是由于主体癌和断端癌被消除。     

切除术后食管残端癌的放射治疗

从1969年至1984年,采用小野照射30例食管术后残端癌患者,组织量50Gy～70Gy/5～7周。其它未治疗的53例做为对照。两组5年生存率分别是43.3％(13/50)和22.6％(12/53),P<0.05.放射治疗对残端原位癌与浸润癌效果不一样,残端浸润癌术后放疗非常必要,而原位癌仅需临床观察。     

脉管癌栓形成与食管、贲门癌术后标本断端残癌关系的研究

 本文对27例癌组织中脉管癌栓阳性病例的术后标本断端残癌进行了研究．结果显示，其残癌发生率为25.9%(7/27)，显著高于癌栓阴性对照组8.9%(8/89)(P＜0.05)．表明有癌栓形成的肿瘤恶性程度高，浸润扩展范围广，易发生残癌．文中对癌组织中癌栓形成与淋巴结转移的关系及其对患者预后的影响进行了讨论．     

食管癌切除术后食管残端癌的放射治疗

食管癌手术切除,食管断端发现有癌残留时,放射治疗是常用及主要的治疗方法。本文分析了我院自1969年10月至1984年12月间放射治疗(用小野照射吻合口)的食管残端癌患者30例,并以同期病情相似而未作术后放疗的53例作非随机性对比,结果5年生存率放疗组为43.3％,未放疗组为22.6％,     

食管癌切除标本断端组织的流式细胞分析及其临床意义

为探讨食管癌切除标本断端组织的细胞生物学特性与术后复发的关系，本文应用流式细胞术（ｆｌｏｗ，ｃｙｔｏｍｅｔｒｙ，ＦＣＭ），对３３例食管癌术后标本的断端组织的ＤＮＡ含量（ＤＮＡｉｎｄｅｘ，ＤＩ）、倍体类型和细胞增殖指数（ｐｒｏｌｉｆｅｒａｔｉｖｅｉｎｄｅｘ，ＰＩ）进行了定量研究。结果发现，切距（主体癌上缘与上切缘之间的距离）＜５厘米的断端，不典型增生性断端及癌残留断端的ＰＩ值显著高于切距≥５厘米断端和正常食管粘膜；随访资料表明，上述三类断端患者的术后五年生存率也显著低于切距≥５厘米切除的患者。尤其有意义的是，１２例切距＜５厘米断端样品中，９例ＰＩ＞２０％，占７５％；且有２例异倍体ＤＮＡ含量出现。提示切距＜５厘米切除者（尤其是术后ＦＣＭ检测，高ＰＩ和高ＤＮＡ含量者），断端不典型增生者及断端癌残留者，都可能成为术后复发的高危人群，应密切随防。文中对残癌与其主体癌之间的ＦＣＭ参数也进行比较研究，从而为残癌的术后放、化疗提供了细胞生物学依据。     

1162例食管癌病理标本亚临床病灶范围的研究

目的研究食管癌病理组织学标本纵轴方向亚临床病灶侵犯范围,为食管癌放疗CTV范围的确定提供参考。方法分析1162例颈、胸段食管癌手术标本的癌上、癌下切除长度与残端阳性的关系。52例食管癌手术标本制成病理大切片,测量标本固定后食管癌及其癌上、下正常组织收缩比例,回推食管癌CTV范围在人体内的实际情况。结果标本固定后,癌上切除范围≤0.5 cm组上残端阳性率高于癌上切除范围>0.5 cm组(16.4%∶4.1%,P=0.000);癌下切除范围≤1.5 cm组下残端阳性率高于癌下切除范围>1.5 cm组(8.1%∶0.4%,P=0.000);癌上、癌下切除正常组织范围>1.5 cm时上残端阳性率高于下残端阳性率(3.5%∶0.4%,P=0.000)。52例食管癌标本制成病理大切片后癌上组织收缩为术中长度的30%±14%,癌下组织收缩为术中长度的44%±19%。结论考虑到标本固定后正常食管的收缩率,食管癌放疗时CTV在GTV范围纵向上外扩2.0 cm,纵向下外扩3.5 cm可能是较为合适的范围。食管癌上行型侵犯概率高于下行型侵犯。     

食管癌术后切缘癌39例分析

食管瘤外科治疗中，切除的食管在其断端查见癌细胞并非罕见，对此发生的原因及其意义，文献鲜有报导。本文就本所1000例食管癌切除标本经病理检查出断端切缘癌39例，占3．9％，现作如下分析。资料与结果一、临床资料男性25例，女性14例，上断端切缘癌33例（其中包括原位癌4例），下断端切缘癌6例。胸下段食管瘤29例，胸中段食管癌10例。39例中食管肿瘤最长6cm，最短3cm。二、临床病理资料切除标本1000例均送病理检查，对标本的上、下断端常规进行切片诊断，结果发现切缘有癌细胞残留39例，占全部切除病例的3．9％，上切线33例，占3，3％。从…     

术前放疗可提高直肠癌切除患者的存活率

将1168例≤80岁拟行直肠癌切除患者随机分组。术前放疗加手术治疗组照射5次/周,共25Gy后1周内行手术,另一组为单独手术组。剔除不适合条件者,术前放疗组局部复发率显著低于单独手术组,前者为11％(63/553),后者为27％(150/557),P<0.001。随访5年,术前放疗组5年生存率为58％,单独手术组为48％(P=0.004)。肿瘤切缘无肿瘤,为有效局部切除,有效     

外科治疗食管,贲门区多原发癌33例分析

本文报告外科治疗食管、贲门区多原发癌33例,占同期外科治疗食管癌和贲门癌的1.1％(33/3001)。男女之比为4.5:1,术前诊断率27％,术后1、3及5年生存率为68％、25％及16.7％。并对食管、贲门区多原发癌的发病率、术前误诊原因、诊断和治疗方法进行讨论。     

直肠癌的放射治疗(综述摘要)

术前放疗:美国Oregeon省保健科学中心大学对97例直肠乙状结肠癌进行了高剂量术前照射(5000～6000rad)。放疗后4～7周外科切除。其中57例可切除病例中40例做了根治性切除,5年无病生存者21例(53％),较过去仅行外科切除5年生存率38％有明显的提高。术前行2000～2500rad放疗完全切除者盆腔复发率为29％,而单纯外科切除盆腔复发率为37％。经过术前照射切除的标本仅有28.7％发现有阳性淋巴结,而仅行手术的则是41.2％。     

Preoperative and adjuvant therapies for upper gastrointestinal cancers

Survival of esophageal, gastrointestinal junction and gastric cancers is poor given that they frequently present with locally advanced or metastatic disease. The incidence of gastrointestinal junction adenocarcinoma is increasing whereas that of squamous cell carcinoma of the esophagus is decreasing. The accuracy of staging has improved with newer diagnostic techniques, including positron emission tomography, endoscopic ultrasound and laparoscopy, and this should be integrated in prospective Phase III clinical trials evaluating neoadjuvant and adjuvant therapies for some esophageal and all gastric carcinomas. For esophageal cancer (except for one trial by Walsh and colleagues), four randomized Phase III trials comparing preoperative chemoradiation followed by surgery versus surgery alone have not shown a survival benefit. Neither have the trials, where preoperative chemoradiation followed by surgery, is compared with definitive chemoradiation. Nevertheless, it is commonly practiced in the USA and has become a preferred combined modality approach. Postoperative chemoradiation is favored in the USA for good performance status patients with resected, high-risk gastric or gastroesophageal junction carcinoma (more than Stage IA). The UK–MAGIC trial results, showing survival benefit with perioperative chemotherapy in operable gastric and lower esophageal cancers, probably has an impact on the treatment practice of these cancers in Europe and Asia. Promising results from trials involving preoperative chemoradiation followed by surgery in gastric cancer (pathologic complete response of 20–30%) need to be further evaluated in a Phase III setting and compared with postoperative chemoradiation. Active ongoing research will help us clarify the role of preoperative and adjuvant therapies in esophageal and gastric cancers. The role of molecular profiling is evolving and will help us differentiate the responders from the nonresponders.     

Hyperthermochemoradiotherapy for esophageal cancer (review).

Hyperthermia is effective for the treatment of cancer when applied concomitantly with chemotherapy and irradiation. However, it is difficult to heat deep portions of the body including the esophagus. Cancer of the esophagus still poses considerable treatment problems, with a poor 5-year survival rate after surgery, an even worse outlook after radiation and surgery, and a not very satisfactory response to chemotherapy. We, therefore, devised an electrode for radio frequency, and we have been successfully using this electrode in the treatment of esophageal cancer. The 5-year survival rates of patients with esophageal cancer, given either preoperative hyperthermochemoradiotherapy or chemoradiotherapy, were 43.2 and 14.7%, respectively. Immediate improvement of subjective complaints and decrease or elimination of the cancer lesion are so distinct that this treatment, by means of an endotract antenna, shows promise as a modality for esophageal lesions.     

胃大部切除术后食管癌的外科治疗

目的：探讨胃切除术后食管癌的外科手术治疗。方法：通过我科的39例手术,结合文献分析胃大部切除术后食管癌手术切除重建的各种术式方法及优缺点。结果：上段食管癌切除应以横结肠代食管重建为佳,中下段食管癌以残胃代食管重建最理想,也可以用空肠代食管重建。结论：胃大部切除术后食管癌是可以通过手术再根治的,食管的重建以残胃最接近生理及解剖学,术式简单,安全,易行。     

放射治疗与手术切除在上段食管癌中的疗效分析

 目的 比较手术治疗与放射治疗在上段食管癌治疗中的疗效差异。方法 回顾性分析2004年1月～2008年3月年在安阳肿瘤医院接受治疗的上段食管癌患者 500例,其中男性 283例,女性 217例;年龄 34～84岁（中位年龄 61岁）;病理类型均为鳞癌;首次治疗手术组 259例,放疗组241例。统计分析采用 SPSS13.0软件包,生存分析采用Kaplan-Meier生存曲线法。 结果 全组 1、3、5年生存率分别为 90%、 74%、 56% 。手术组为 90.2%、74.0%、 53.3%。放疗组为 90.3%、73.4%、 58.2%。手术组和放疗组中位 OS ( 97m vs 112m) 无明显差异 (χ2 =0.156, P=0.693);接受交叉治疗的患者较未接受交叉治疗的患者有更长的中位生存期 (χ2 =6.893, P=0.009);化疗的参与对于手术组和放疗组的生存期没有明显影响(P 值分别为0.623和0.826)。结论 手术治疗和放射治疗对上段食管癌的疗效没有明显差异;两种治疗手段联合较单一治疗手段有更好的临床结果;化疗在上段食管癌治疗中的意义尚不明确。     

可手术食管癌采用手术与放射治疗的随机对照研究

目的探讨对可手术治疗的食管癌患者,采用后程加速超分割适形放射治疗与手术治疗的疗效。方法对269例可手术的胸段食管癌患者进行随机分组,手术组135例,放疗组134例。手术组距肿瘤上下缘各5cm以上切除食管及其周围的淋巴脂肪组织,常规摘检≥5mm的区域淋巴结。放疗组临床靶区（CTV）前程设野原则：胸上段食管癌包括双侧锁骨上区及病变下缘以下4cm,胸中段食管癌上下缘各外放4cm,胸下段食管癌包括上缘以上4cm及胃左淋巴引流区,食管处宽度5～6cm,以90％的等剂量曲线包绕CTV,设3～5个照射野,常规分割,每次1．8～2．0Gy,照射50．0～50．4Gy,然后缩野（病变上下缘各外放2cm）加速超分割（1．5Gy／次,2次／d,间隔≥6h）照射18～21Gy,总剂量为68．4～71．0Gy。结果放疗组1、3、5年总生存率分别为88．6％、56．2％和34．7％,手术组分别为93．3％、61．5％和36．9％,两组间差异无统计学意义。手术组1、3、5年无进展生存率,分别为75．9％、43．7％和23．1％,放疗组分别为73．3％、39．7％和20．6％,两者间差异亦无统计学意义。结论可手术的食管癌采用后程加速超分割适形放射治疗,其疗效与手术治疗相当。     

术前新辅助化疗联合手术切除治疗局部晚期食管癌的疗效观察

【摘要】目的:研究术前紫杉醇+顺铂新辅助化疗联合手术切除在局部晚期食管癌治疗中的临床效果。方法:选取2014 年 1 月 ～2016 年 12 月我院治疗局部晚期食管癌患者 60 例,进行随机分组,对照组 30 例仅在术后给予化疗治疗,观察组 30 例在手术前应用紫杉醇+顺铂新辅助化疗方案治疗,再进行手术治疗,比较两组患者食管癌完全切除率、1年复发率。结果:观察组食管癌完全切除率明显高于对照组,1年复发率低于对照组,差异均有统计学意义(P ＜0. 05)。结论:术前应用紫杉醇+顺铂新辅助化疗联合手术切除治疗局部晚期食管癌临床效果理想。     

颈段食管癌治疗方法的探讨

分析 1 70例颈段食管癌 ,以探讨颈段食管癌的治疗方案。术前放疗加手术综合治疗 30例 ,单纯手术 2 7例 ,单纯放疗 1 1 3例 ,术前放疗剂量为DT4 0Gy/4周 ,疗后 3个月内行手术 ,单纯放疗剂量为DT5 0Gy/5周以上 ,综合治疗、单纯手术与单纯放疗其 5年生存率分别为 4 0 .0 %、1 5 .3%与 2 8%。综合治疗与单纯手术间有统计学差别 (P <0 .0 5 ) ,且并发症发生率、手术有关死亡率相似。颈淋巴结转移是影响单纯放疗预后的重要因素 ,单纯放疗主要失败原因为局部未控复发 ( 71 .0 % ) ,综合治疗主要失败原因为淋巴结转移 ( 81 .0 % )。我们认为综合治疗能提高颈段食管癌的生存率 ,而根治性单纯放疗也是主要的治疗方法之一。术前放疗剂量 ,在食管局部为DT4 0Gy/4周 ,双下颈锁骨上预防时为DM4 5～5 0Gy ,有淋巴结转移时应给予DM5 0Gy以上 ,同时行淋巴结转移侧颈清扫术。     

Non-standard combination of radiation and surgery for esophageal cancer.

Three schemes of nonstandard combination of irradiation and surgery for esophageal cancer are presented: individual approach (IA), dynamic planning (DP), and sequential scheme (SS). In IA preoperative fractionation is adjusted to the tumor size. In DP esophageal resection is performed only in nonresponders to small-fraction 40-45 Gy radiation. In SS surgery is performed after radiation with greater than 50 Gy for residual esophageal tumor or reappearance of the tumor.     

Management of Cervical Esophageal Carcinoma

Surgery and radiotherapy yield equivalent results for patients with carcinoma of the cervical esophagus, with long-term survival of less than one in four patients. The advantages of radiotherapy are lower rates of acute morbidity and mortality compared with surgery, and potential for larynx preservation. The advantage of surgery is that the transposed stomach may function better over the long term than an irradiated esophagus, which tends to become stenotic over time. Patients with resectable cancers who are in good general medical condition may be treated with preoperative irradiation and surgery in an effort to improve the likelihood of local control and obtain a good functional result. Patients with relatively early lesions who are not good surgical candidates can be treated with high-dose radiation therapy. Patients with very advanced local disease and those with distant metastases are treated with palliative irradiation. Concurrent chemotherapy and radiotherapy has been shown to be superior to radiotherapy alone in managing esophageal cancer. Although relatively few patients with cervical esophageal cancer have been treated with this combination, some studies suggest it may be curative for patients with early lesions of the cervical esophagus, without the need for esophagectomy. Adjuvant chemotherapy is usually not used outside of a study setting.     

The Stockholm preoperative radiotherapy of operable breast cancer. Preliminary report

The 4 year results of a prospective clinical trial on the treatment of operable breast cancer, comparing the effects of preoperative radiotherapy followed by surgery with those of surgery followed or not by postoperative radiotherapy are presented for patient groups of approximately 100 each. At 4 years 85 per cent survive after preoperative radiotherapy plus surgery, as against 77 per cent after surgery only and 81 per cent after surgery plus postoperative radiotherapy. These differences are not statistically significant. The incidence of local recurrence after radiotherapy was reduced to 1/4 of that seen after surgery only. The radiation could be shown to induce temporary damage in a number of immunological parameters. No correlation could be demonstrated between these findings and the clinical course of the disease.