逐步递量加速超分割照射加化疗非小细胞肺癌

目的 观察逐步递量加速超分割放射治疗（ＥＨＡＲＴ）Ⅲｂ期非小细胞肺癌（ＮＳＣＬＣ）的近期疗效和急性放射反应。方法 ７３例Ⅲｂ期ＮＳＣＬＣ进入ＥＨＡＲＴ组。放射治疗的第１,２周,１．２Ｇｙ２次／ｄ间隔６ｈ以上,第３,４,５周分别为１．３,１．４,１．５Ｇｙ２次／ｄ,均５天／周,照射野仅包括胸部ＣＴ或ＭＲＩ可见的原发灶和淋巴结转移以及周围１．０～１．５ｃｍ的正常组织。肿瘤灶总剂量６６Ｇｙ,５０次,５周     

加速超分割放射治疗鼻咽癌前瞻性研究的近期结果

目的：为了探讨加速超分割放射治疗鼻咽癌的临床效果和早、晚期放射反应。方法：１９９５年１月～１９９６年７月首次住院放疗的鼻咽癌患者２６６例。随机分为加速超分割（ＡＨＦ）和常规分次（ＣＦ）对照两组，均经ＣＴ或ＭＲＩ检查及Ｐｌａｔｏ治疗计划系统设计布野。对鼻咽部ＡＨＦ组方案为ＤＴ７９．２Ｇｙ／７２次／２４个治疗日，全程３２天，１．１Ｇｙ／次，每天３次，各次之间间隔＞６ｈ；对照组的方案是ＤＴ７０Ｇｙ／３５次７周，２Ｇｙ／次，每周５次。颈结（＋）给予治疗量，ＡＨＦ组７９．２Ｇｙ，对照组７０Ｇｙ；颈结（－）给予预防量，ＡＨＦ组５０Ｇｙ，对照组４５Ｇｙ。结果：ＡＨＦ组的疗终病灶全消和１年生存率优于对照组，差异有统计学意义。而急性放射反应，则明显重于对照组，皮肤粘膜Ⅲ度放射反应增多。差异非常显著。实验组有１０．７％患者需要短期中断疗程和支持治疗。结论：加速超分割放疗鼻咽癌的近期效果较好，疗终病灶全消率和１年生存率均优于常规分次组（Ｐ＜０．０１和０．０５）。虽然急性放射反应较重，但大多数患者可以耐受。     

非小细胞肺癌加速超分割放疗临床Ⅰ／Ⅱ期试验

目的观察非小细胞肺癌（ＮＳＣＬＣ）加速超分割（ＨＡＲＴ）放疗的副反应及疗效。材料与方法１９９１年１２月～１９９４年１２月，６９例进入本研究（９例未完成放疗计划）。ＨＡＲＴ放疗，３次／天，１．１Ｇｙ／次，间隔４小时，总刑量７２－７６Ｇｙ／６６－６９次／３３（２９－４２）天。对照组（ＣＦＩ），１次／天，１．８－２．０Ｇｙ／次，总剂量６２－６５Ｇｙ／３２－３６次／４８（４５－５２）天。结果（１）急性放射性食管炎：ＨＡＲＴ组８７％（５２例），ＣＦＩ组４４％（２２例）（Ｐ＜０．００１）。（２）两组肺急性及后期放疗反应均无差异（Ｐ值均＞０．０５）。（３）即期嵙菩В海龋粒遥宰榛航饴剩ǎ茫遥校遥┪福埃ィ庞冢茫疲勺榈模常福ィǎ校迹埃埃埃保＃ǎ矗┥媪菩В海保玻衬晟媛剩龋粒遥宰槲罚玻ィ矗罚ィ玻福ィ茫疲勺槲叮埃ィ保福ィ叮ィǎ校迹埃埃埃保＃龋粒遥宰榫挚芈室灿庞冢茫疲勺椋ǎ校剑埃埃埃保洞ψ坡氏灾儆冢茫疲勺椋ǎ校剑埃埃玻保＞茫希囟嘁蛩胤治鼋峁荆龋粒遥蕴岣吡松婕熬挚芈剩档土嗽洞ψ坡省＝崧郏ǎ保龋遥粒灾瘟颇芪蠖嗍危樱茫蹋媚褪埽ǎ玻龋粒遥苑帕铺岣吡松媪菩А     

逐步递量加速超分割放射治疗局部晚期鼻咽癌

目的：研究逐步递量加速超分割放射治疗（ＥＨＡＲＴ）局部晚期鼻咽癌的近期疗效和急性反应。方法：１９９９年４月－２０００年２月６４例Ｔ３－４Ｎ０Ｍ０、ＫＰＳ≥８０的鼻咽癌患者进入本研究,并随机分为常规分割放疗（ＣＦＲＴ）组和ＥＨＡＲＴ组,每组各３２例;ＣＦＲＴ组采用２Ｇｙ／次,５次／周的方法,鼻咽靶区中心总剂量６８－７６Ｇｙ,中位数７０Ｇｙ,３４－３８次,７－８周;上颈部剂量４６－５６Ｇｙ,２３－２８     

连续加速超切割与后程加速超分割治疗食管癌

目的 比较连续加速超分割（ＣＡＨＦ）和后程加速超分割（ＬＣＡＦ）放射治疗食管癌的疗效和毒性。方法 １０１例食管鳞癌患者前瞻性随机分成２个组。ＬＣＡＦ组（５２例）前２／３疗程为常规分割（５次／周,１．８Ｇｙ／次）,照射４１．４Ｇｙ后缩野改加速超分割（２次／ｄ,１．５Ｇｙ／次）照射２７Ｇｙ,总量６８．４Ｇｙ,４１次,４４～４６ｄ,ＣＡＨＦ组（４９例）从治疗开始,２次／ｄ,１．５Ｇｙ／次,照射至３９Ｇｙ     

诱导化疗加放疗与单纯放疗不能手术的Ⅲ期非小细胞肺癌

目的评价诱导化疗加放射治疗不能手术的Ⅲ期非小细胞肺癌（ＮｏｎＳｍａｌＣｅｌＬｕｎｇＣａｎ－ｃｅｒ，ＮＳＣＬＣ）疗效。材料与方法１１１例不能手术的Ⅲ期ＮＳＣＬＣ病人被随机分为两组：５５例病人接受丝裂霉素８～１０ｍｇ／ｍ２，第１天；顺铂２０ｍｇ／ｍ２，第１～５天；长春花碱６ｍｇ／ｍ２，第６天（或长春酰胺３ｍｇ／ｍ２第１，８天）联合化疗（ＭＰＶ方案）；２～４疗程后给予放疗（化放组）。５６例病人接受单纯放疗（单放组）。两组放疗方式和剂量相同，常规分割放射，每次２Ｇｙ，每周５次。原发灶和淋巴结受累部位的总剂量为６０～６８Ｇｙ，淋巴引流区５０Ｇｙ。结果化放组总有效率为６３．６％，完全缓解（ＣＲ）１４．５％，中位生存期为１４个月；单放组总有效率为５５．４％，ＣＲ５．４％，中位生存期为１０个月。两组的总有效率无差别（Ｐ＞０．２５），但生存期有明显的差异（Ｐ＜０．０２５）。化疗的毒副反应主要是胃肠道反应和骨髓抑制。两组放疗副反应（急性和迟发性肺损伤）相似。结论诱导化疗加放射治疗不能手术的Ⅲ期ＮＳＣＬＣ，毒性可耐受，生存期优于单纯放疗。     

异基因外周血造血干细胞移植治疗白血病

５例白血病患者接受ＨＬＡ相合异基因外周血干细胞移植。外周血干细胞动员采用供者连续皮下注射Ｇ－ＣＳＦ（１０μｇ／ｋｇ）５天，于第５天和第６天用ＣＳ３０００Ｐｌｕｓ血细胞分离机分离单个核细胞（ＭＮＣ）。患者平均输入ＭＮＣ６．０×１０８／ｋｇ，ＣＤ３４＋细胞２２．６×１０６／ｋｇ，ＣＤ３＋细胞４１２×１０６／ｋｇ，ＣＤ４＋细胞２０５×１０６／ｋｇ和ＣＤ８＋细胞１６２×１０６／ｋｇ。移植后造血重建迅速，中性粒细胞绝对计数＞０．５×１０９／Ｌ和血小板计数＞２０．０×１０９／Ｌ的平均时间分别为１３．４天和１１．４天。５例均未发生急性ＧＶＨＤ，２例发生慢性ＧＶＨＤ。供者对大剂量Ｇ－ＣＳＦ耐受良好     

SHORT－TIME EFFECTS OF BRONCHIAL ARTERY INFUSION WITH CHEMICAL DRUGS FOR LUNG CANCER

ＳＨＯＲＴ－ＴＩＭＥＥＦＦＥＣＴＳＯＦＢＲＯＮＣＨＩＡＬＡＲＴＥＲＹＩＮＦＵＳＩＯＮＷＩＴＨＣＨＥＭＩＣＡＬＤＲＵＧＳＦＯＲＬＵＮＧＣＡＮＣＥＲＹａｏｙａｎｇ姚阳；ＰａｎＹｕｅｙｉｎ潘跃银（ＣａｎｃｅｒＲｅｓｅａｒｃｈＩｎｓｔｉｔｕｔｅ，Ａｆｆｉｌｉ...     

rhG-CSF预防恶性肿瘤化疗后粒细胞减少的Ⅱ期临床研究

目的：评价ｒｈＧ－ＣＳＦ（粒生素）对预防恶性肿瘤化疗后粒细胞减少的作用及不良反应。方法：人组总数６３例,均为病理或细胞学证实的恶性肿瘤。采用自身交叉方法将患者随机分入ＡＢ和ＢＡ两组。Ａ为治疗周期,即化疗用药结束４８ｈ开始,每日１次皮下注射ｒｈＧ－ＣＳＦ ５μｇ／ｋｇ,连续用药７～１４ｄ。Ｂ为空白对照周期。自化疗开始隔日查血常规１次,观察中性粒细胞（ＡＮＣ）及白细胞（ＷＢＣ）的变化。结果：治疗组于ｒｈＧ－ＣＳＦ注射２４ｈ后,ＷＢＣ及ＡＮＣ迅速上升,４８ｈ出现第１个高峰,第１０天出现第２个高峰,而对照组化疗后,ＷＢＣ和ＡＮＣ逐渐下降,始终低于治疗组。ＷＢＣ,ＡＮＣ的最低值、ＷＢＣ＜４．０×１０９／Ｌ、ＡＮＣ＜２．０×１０９／Ｌ的持续时间,以及化疗后第２１天ＷＢＣ＜４．０×１０９／Ｌ的病例数在治疗组和对照组间差异有显著性（Ｐ＜０．０５）。结论：ｒｈＧ－ＣＳＦ可以促进化疗患者ＷＢＣ和ＡＮＣ的恢复,耐受性良好,可以作为肿瘤化疗中提高剂量强度的有效辅助药。     

非小细胞肺癌后程加速超分割放疗疗效观察

目的：通过前瞻性的研究非小细胞肺癌（ＮＳＣＬＣ）后程加速超分割放疗的疗效，寻找ＮＳＣＬＣ的最佳治疗手段。方法：对１９９３年１月～１９９６年７月我院收治的７０例ＮＳＣＬＣ患随机分组研究。常规组３５例：用＾６０Ｃｏ或８Ｍｖ－ｘ，５次／Ｗ，２Ｇｙ／次，总剂量７０Ｇｙ／３５次／７～８Ｗ。后程加速超分割组３５例：放疗前程为常规分割，２Ｇｙ／次，４０Ｇｙ／２０次／４Ｗ后改野，５天／Ｗ，２次／天，１．８Ｇｙ／     

Current Evidence for Stereotactic Body Radiotherapy in Lung Metastases

Lung metastases are the second most common malignant neoplasms of the lung. It is estimated that 20–54% of cancer patients have lung metastases at some point during their disease course, and at least 50% of cancer-related deaths occur at this stage. Lung metastases are widely accepted to be oligometastatic when five lesions or less occur separately in up to three organs. Stereotactic body radiation therapy (SBRT) is a noninvasive, safe, and effective treatment for metastatic lung disease in carefully selected patients. There is no current consensus on the ideal dose and fractionation for SBRT in lung metastases, and it is the subject of study in ongoing clinical trials, which examines different locations in the lung (central and peripheral). This review discusses current indications, fractionations, challenges, and technical requirements for lung SBRT.     

Primary liposarcoma of the lung: Report of a case

We reported one case of a primary liposarcoma of the lung which has been reported only in six cases to date worldwide, and we added some documented study. A 49-year-old female complained of exertional dyspnea with about 100 ml of hemoptysis. The chest X ray showed a coin lesion at the left upper field. After left pneumonectomy, the histological examination revealed liposarcoma of the lung. Six months after the operation, she died from severe dyspnea; the autopsy revealed the relapse of liposarcoma in the right lung, and no liposarcomas in other organs. This is the seventh case according to a worldwide review of the literature.     

Amylase-producing lung cancer

A bronchioloalveolar carcinoma of lung associated with hyperamylasemia occurring in a 40-year-old woman is described. Another 13 cases of such a tumor from the English literature are reviewed. A majority of the lung tumors associated with hyperamylasemia were adenocarcinomas. When the amylase isoenzymes were determined, the amylase appeared to be salivary-gland type (S-type). Electron microscopic studies had revealed membrane-bound electron-dense granules within the tumor cells.     

Lymphadenectomy during pulmonary metastasectomy: Impact on survival and recurrence

Background and Objectives: Lymphadenectomy during pulmonary metastasectomy (PM) is widely carried out. We assessed the potential benefit on patient survival and tumor recurrence of this practice. Methods: One hundred eighty-one patients undergoing a first PM were studied. Eighty-six patients (47.5%) underwent lymphadenectomy (L+ group) whereas 95 (52.5%) did not undergo nodal harvesting (L−group). Main outcomes were overall survival (OS) and disease-free survival (DFS). Median follow-up was 25 months (interquartile range [IQR], 13-49). Results: At follow-up 84 patients (46.4%) died, whereas 97 (53.6%) were still alive with recurrence in 78 patients (43%). There was no difference in 5-year survival (L+ 30.0% vs L− 43.2%; P = .87) or in the 5-year cumulative incidence of recurrence (L + 63.2% vs L−80%; P = .07) between the two groups. Multivariable analysis indicated that disease-free interval (DFI) less than 29 months (P < .001) and lung comorbidities (P = .003) were significant predictors of death. Metastases from non-small–cell lung cancer increased the risk of lung comorbidities by a factor of 19.8, whereas the risk of DFI less than 29 months was increased nearly 11-fold. Competing risk regression identified multiple metastases (P = .004), head/neck primary tumor (P = .009), and age less than 67 years (P = .024) as independent risk factors for recurrence. Conclusion: Associated lymphadenectomy showed not to give any additional advantage in terms of survival and recurrence after PM.     

Bleomycin-associated pulmonary fibrosis: rapidly fatal progression without chest radiotherapy

Two patients with carcinoma of the tonsil were treated with bleomycin (396 and 224 units, respectively) but not with radiotherapy. Respiratory insufficiency led to death 45 and 52 days, respectively, after onset of therapy. Chest radiographs before bleomycin therapy revealed no evidence for lung disease. Postmortem examinations showed severe interstitial and intraalveolar pulmonary fibrosis. Comparably rapid progression from radiographically normal pulmonary parenchyma to fatal fibrosis has been documented previously only in patients with thoracic neoplasia as well as, in all but one instance, either prior or concurrent chest radiotherapy. These two cases indicate that chest radiotherapy is not a necessary cofactor for the development of rapidly progressive, fatal, diffuse interstitial pulmonary fibrosis after bleomycin therapy.     

NaPi2b expression in a large surgical Non-Small Cell Lung Cancer (NSCLC) cohort

BackgroundNaPi2b is a multi-transmembrane sodium-dependent phosphate transporter expressed at normal levels in several organs, including lung. High expression levels have been reported in various tumors including breast, thyroid, ovarian and non-small cell lung cancer. To date evaluation of NaPi2b expression has mostly been restricted to smaller lung cancer cohorts.MethodsAnalyses were performed on archival formalin fixed paraffin embedded primary tumor specimens from patients who had undergone curative intent resection at an Australian tertiary hospital. Tissue microarrays were constructed and stained with the chimeric anti-NaPi2b antibody, MERS67. Semi-quantitative H-scores (range 0 – 300) were calculated for each core tissue sample (H-score = % tumor cells staining for NaPi2b multiplied by staining intensity). An overall average H-score was reported for each specimen, with a cut-off score of 50 considered positive.ResultsOf 438 cases, high NaPi2b expression was observed in 151 (34.5%) overall, high expression in 137 of 208 (65.9%) adenocarcinoma cases, and 5 of 179 (2.8%) squamous cases (P < .0001). High NaPi2b expression was associated with female sex, EGFR or KRAS mutation, and TTF1 positivity (adenocarcinoma cases only). High NaPi2b expression was associated with improved overall survival (median 54 vs. 35 months, P = .029).ConclusionHigh NaPi2b expression was noted in a significant subset of adenocarcinoma cases, and in particular amongst those who were TTF1+, or exhibited EGFR or KRAS mutations. This agrees with earlier reports and highlights the significance that NaPi2b may have a role as a possible target for delivery of cytotoxic agents via antibody-drug conjugate models for some patients with lung adenocarcinoma.     

Importance of biologic status to the postoperative prognosis of patients with stage III nonsmall cell lung cancer

The prognosis of patients with stage III nonsmall cell lung cancer was studied, with special attention to their biologic status prior to lung resection. The biologic status was estimated from the neutrophil/lymphocyte ratio in the peripheral blood, serum albumin level, and erythrocyte sedimentation rate. Among 46 patients who underwent potentially curative operations, 31 cases of biologic status A or B (more than two parameters normal) revealed 37.6% of a 5-year survival rate, whereas there was no 5-year survivor in 15 cases of biologic status C or D (more than two parameters abnormal). Of the 5-year survival rate in T3N0 disease of biologic status A or B, the 60% surviving (of 10 cases) was in marked contrast to the same stage disease of biologic status C or D where only 1 patient (of 10 cases) was still surviving at more than 30 months. In 30 patients with T3N0, T3N1, and T2N2 diseases of biologic status A or B, where long-term survivors were derived, the 5-year survival rate in 30 patients of biologic status A or B was 36.6% in contrast to no long-term survivor in the same stage diseases of biologic status C or D (n = 25). We conclude that surgical results in stage III nonsmall cell lung cancer will be beneficial in patients of biologic status A or B, but nonbeneficial in patients with the same stage of biologic status C or D.     

电视辅助胸腔镜肺叶切除术治疗非小细胞肺癌的疗效观察

目的 比较电视胸腔镜下肺叶切除与开胸肺叶切除治疗早期非小细胞肺癌的临床效果.方法 收集81例初诊为早期非小细胞肺癌实施手术治疗的患者为研究对象,并将其分为2组:观察组和对照组.观察组给予胸腔镜肺叶切除术,对照组给予开胸肺叶切除术.比较2组患者手术时间、术中出血、术后拔管时间、住院时间及术后并发症情况.定期随访,比较患者术后3个月、6个月、12个月及3年的生活质量及3年生存率.结果 2组患者的手术时间、拔管时间无明显差异(P>0.05),但观察组患者术中出血及住院时间明显低于对照组(P<0.05).观察组患者有7例出现肺部感染,并发症发生率17.1%;对照组患者并发症合计16例,并发症发生率为40.0%.观察组并发症发生率明显低于对照组(P=0.022).术后第3个月、6个月观察组患者的生存质量明显高于对照组(P<0.05),术后第12个月2组患者的生存质量无明显差异(P>0.05).观察组3年生存率为29.3%,对照组的生存率为30.0%,差异无统计学意义(P=0.994).结论 电视胸腔镜下肺叶切除术治疗非小细胞肺癌,手术创伤小,术中出血少,术后并发症少,术后生存质量高,术后3年生存率与开胸肺叶切除术无明显差异,近期效果满意.     

逆行肺切除在肺癌继发肺脓肿治疗中的应用

目的:探讨逆行肺切除在肺癌继发肺脓肿治疗中应用的可行性。方法:回顾性分析16例肺癌继发肺脓肿患者术中采用逆行肺切除术,即先处理支气管后处理肺血管的临床资料。结果:全组无围手术期死亡,恢复良好。结论:逆行肺切除在肺癌继发肺脓肿外科治疗中是可行的。     

诱导性同步放化疗治疗侵袭性肺上沟瘤

目的分析同步放化疗(CRT)在NSCLC外科治疗的地位.方法回顾性总结1987～1996年外科手术的30例累及胸顶部的NSCLC,单纯手术组10例,手术+放疗组(RT)9例,含铂方案化疗+放疗组(CRT)11例.结果单纯手术组2、4年生存率分别为30%和20%, RT组为22% 和11%,CRT组为73% 和53%.单因素分析根治性(是与否比较,P=0.027)和诱导性治疗(单纯手术和RT与CRT比较,P=0.0173)是有意义的预后因素.多因素分析仅诱导性治疗,P=0.023 8,是有意义的预后因素.结论与诱导性放疗和单纯手术相比,CRT可提高累及胸顶部的NSCLC患者的生存率.