术中射频消融、~(125)Ⅰ放射性粒子植入联合区域性灌注化疗治疗中晚期胰腺癌

目的探讨术中射频消融、125I放射性粒子植入联合区域性灌注化疗治疗中晚期胰腺癌的疗效。方法回顾性分析2004年1月～2008年12月我院收治的34例中晚期胰腺癌患者的临床资料,分为2组,实验组16例采用术中射频消融、125I放射性粒子植入联合区域性灌注化疗治疗,对照组18例采用单纯区域性灌注化疗,对比2组患者治疗后疗效、疼痛缓解程度、生存期、不良反应及CA19-9变化。结果实验组治疗有效率(81.25%)高于对照组(27.78%);实验组治疗后CA19-9低于治疗前及对照组;实验组9、12个月生存率及中位生存期高于对照组;实验组比对照组能够明显改善患者的疼痛症状。结论术中射频消融、125I放射性粒子植入联合区域性灌注化疗治疗中晚期胰腺癌可获得较好的疗效。     

术中射频消融、125I放射性粒子植人联合区域性灌注化疗治疗中晚期胰腺癌

目的探讨术中射频消融、125I放射性粒子植入联合区域性灌注化疗治疗中晚期胰腺癌的疗效。方法回顾性分析2004年1月～2008年12月我院收治的34例中晚期胰腺癌患者的临床资料,分为2组,实验组16例采用术中射频消融、125I放射性粒子植入联合区域性灌注化疗治疗,对照组18例采用单纯区域性灌注化疗,对比2组患者治疗后疗效、疼痛缓解程度、生存期、不良反应及CA19-9变化。结果实验组治疗有效率（81．25％）高于对照组（27．78％）;实验组治疗后CA19-9低于治疗前及对照组;实验组9、12个月生存率及中位生存期高于对照组;实验组比对照组能够明显改善患者的疼痛症状。结论术中射频消融、125I放射性粒子植入联合区域性灌注化疗治疗中晚期胰腺癌可获得较好的疗效。     

70岁及以上不可切除的胰腺癌患者生存因素分析

目的 探讨影响70岁及以上不可切除的胰腺癌患者生存的相关因素.方法 总结57例70岁及以上的晚期胰腺癌住院患者的临床资料,分析性别、年龄、既往糖尿病史、胆道疾病史、吸烟史、化疗、放疗、美国东部肿瘤协作组(Eastern Collaborative Oncology Group,ECOG)评分、肿瘤标志物癌胚抗原(carcinoembroynic antigen,CEA)和CA199升高情况等对总生存的影响.结果 性别、行为状态、化疗、放疗与生存密切相关.男性和女性比较,中位生存期分别为(10.7±5.4)个月和(5.5±2.3)个月,P=0.000;ECOG评分0～1分和≥2分比较,中位生存期分别为(10.1±5.8)个月和(7.3±3.8)个月,P=0.040;未接受化疗组和接受化疗组比较,中位生存期分别为(7.8±5.3)个月和(11.5±5.0)个月,P=0.038;未接受放疗组和接受放疗组比较,中位生存期分别为(8.9±5.4)个月和(13.7±3.8)个月,P=0.048;差异均有统计学意义.胰腺癌总的中位生存期为8.9个月,1年生存率为28.1%.结论 70岁及以上老年人胰腺癌的预后与性别、行为状态、化疗和放疗相关.对于不可切除但行为状态好的老年胰腺癌患可以考虑化疗,部分患者甚至可以考虑联合放疗.     

颅内血管外皮细胞瘤手术辅助放疗和化疗的效果及病理学分析

目的探讨手术切除颅内血管外皮细胞瘤后辅助放疗和化疗的效果及病理学改变。方法回顾性分析首都医科大学宣武医院经病理学检查证实的17例颅内血管外皮细胞瘤患者的临床资料,分析手术切除肿瘤辅以放疗和化疗的治疗效果。其中男13例,女4例;年龄为28～54岁,平均49岁。肿瘤全切除的15例,术后实施全脑放疗,放射剂量为50～60Gy。肿瘤次全切除的2例,采用伽玛刀治疗,放射剂量为30Gy。术后放疗前、术后2周和8周,采用尼莫司汀化疗3次,150mg/次。结果颅前窝底（6例）及矢状窦前1/3处（3例）肿瘤于手术显微镜下全部予以切除,术后头痛、呕吐、视力下降、复视的症状消失。8例小脑幕肿瘤患者中,6例手术显微镜下全切除肿瘤,2例手术显微镜下次全切除肿瘤。术后头痛症状消失,3例视野缺损症状好转,5例无明显改善。所有患者术后未出现新的神经功能缺损,无死亡病例。病理学检查示：肿瘤内有丰富的血管网,状似＂鹿角＂,这些血管扩张明显,近似血窦,肿瘤细胞围绕着血管排列,有分化和未分化两种细胞。未分化肿瘤细胞内有大量的胞质,核呈圆形或卵圆形,可见核分裂。9例患者的肿瘤有囊变,未见钙化征象。免疫组化提示血管外皮细胞瘤对Vimentine及CD34染色呈阳性反应。术后对所有患者MRI随访6～40个月,未见肿瘤复发。结论颅内血管外皮细胞瘤是一种血管丰富的恶性肿瘤,手术彻底切除肿瘤及术后辅以放疗和化疗,可防治其复发和转移。     

局限性小细胞肺癌化疗后残余瘤的切除

本文为探讨小细胞肺癌(SCLC)化疗后行残余肿瘤切除的可能性,严格选择24例局限性小细胞肺癌患者,化疗前临床分期,Ⅰ期3例,Ⅱ期7例,Ⅲ期14例。24例中11例化疗后完全临床缓解,13例部分临床缓解。此外,24例中有14例作了预防性颅脑放疗。11例完全缓解病人,6例术中未找到肿瘤,而13例部分缓解病人,10例术中发现尚有肿瘤存在。24例开胸术中,9例仅作活检(7例未找到肿瘤,2例明显累及纵隔淋巴结未能切除),15例作肺切除     

70岁以上老年胰腺癌患者的治疗及临床回顾性分析

目的了解70～90岁胰腺癌患者的治疗和生存情况,寻找相关预后因素,确定适合该人群的最佳治疗方法。方法对81例70岁以上胰腺癌患者的各种临床参数、所采取的主要治疗方法及生存时间进行分析。结果81例患者6个月、1年和2年生存率分别为50.2%、19.2%和3.2%,中位生存时间为6.2个月;接受根治术患者中位生存时间为26.5个月,单纯化疗患者中位生存期为6.6个月,放疗＋化疗者为5.7个月,支持治疗者为3.4个月。进一步分层分析显示,单纯化疗与放疗＋化疗比较,中位生存时间：Ⅲ期为8.1个月和11.3个月,Ⅳ期为6.2个月和3.9个月。卡氏评分（KPS）≤80分和有远处转移为预后不良的独立危险因素。结论老年胰腺癌患者早期手术切除可获得较长的生存期,对于一般情况良好者应考虑给予适当化疗,Ⅲ期患者可加用胰腺局部放疗,Ⅳ期患者胰腺局部放疗并未显示益处。KPS评分和是否有远处转移是影响患者预后的独立因素。     

局部放疗联合吉西他滨化疗治疗晚期胰腺癌21例

胰腺癌是消化道常见肿瘤，多数患者确诊时已属晚期，根治性切除机会较少，5a生存率仅1—4％。2005年4月～2008年11月，我们采用局部适形放疗联合以吉西他滨为主的化疗治疗晚期胰腺癌21例，疗效较好。现报告如下。     

阴道肿瘤的诊治(附30例分析)

分析３０例阴道肿瘤患者的临床资料,其中良性阴道肿瘤１４例,原发恶性阴道肿瘤１２例,转移性恶性阴道肿瘤４例,结果显示,良必阴道肿瘤订在表现为阴道肿物,以平滑肌瘤多见,行手术切除即可,阴道恶性肿瘤以阴道黑色素瘤及原发性阴道癌多见,转移瘤多来自邻近器官、其治疗宜行根治术,术后可辅以放疗、化疗及免疫治疗。     

术前影像学检查评估胰腺肿瘤可切除性的价值

目的探讨胰腺癌可切除性的术前评估。方法通过回顾性分析患者术前的CT、MRI、MRCP等影像学资料,对1990年6月至2006年6月间115例胰腺癌患者进行术前可切除性评估。结果本组115例,有29例术前判断为无法切除,86例可切除;术中实际行胰十二指肠切除术的病例为78例,未能手术切除的病例为37例。CT等影像学检查术前判断肿瘤可切除的阳性预测值为87.2%（75/86）,阴性预测值为89.7%（26/29）,准确性为87.8%（101/115）。结论胰腺癌术前可切除性判断,既可提高手术切除率,降低手术风险,减少术后并发症及病死率;同时可避免不必要的手术给患者带来的侵害,提高患者的生活质量。     

不同治疗方式对老年胰腺癌患者生存的影响

目的 观察不同治疗方式对老年胰腺癌患者生存的影响,以确定最佳治疗方法.方法 选择100例老年胰腺癌患者,回顾性分析肝动脉灌注化疗/栓塞、高强度超声聚焦、放射治疗和静脉化疗等不同治疗方式对患者的生存的影响.结果 接受肝动脉灌注化疗/栓塞患者的中位生存期高于未接受肝动脉灌注化疗/栓塞患者,但差异无统计学意义（8.3 mvs6.9m,P＞0.05）;与接受高强度超声聚焦治疗患者比较,未接受高强度超声聚焦治疗患者的中位生存期的差异也没有统计学意义（7.2 vs 7.5 m,P＞0.05）;但接受肝动脉灌注化疗/栓塞联合放疗患者的中位生存期显著高于接受肝动脉灌注化疗/栓塞患者（10.7 mvs 6.3 m,P＜0.01）;接受肝动脉灌注化疗/栓塞联合高强度超声聚焦患者的中位生存期明显高于接受肝动脉灌注化疗/栓塞患者（10.1 mvs 5.8 m,P＜0.01）.结论 早期老年胰腺癌患者采用手术切除可获得长期生存,而中晚期老年胰腺癌患者进行肝动脉灌注化疗/栓塞联合放疗、肝动脉灌注化疗/栓塞联合高强度超声聚焦的治疗可获得较长的生存.     

Microwave ablation in locally advanced pancreatic carcinoma--a new look

BACKGROUND/AIMS: Pancreatic carcinoma is by far the most common malignancy and is the 5th most lethal cancer in the world and 40% of these carcinomas are locally advanced and unresectable at the time of presentation. Palliative surgery and chemoradiotherapy have not produced significant improvement in survival. The overall prognosis of these pancreatic cancers is poor, if left untreated without any form of palliation. Out of many palliative methods adopted for such locally advanced pancreatic carcinoma, none has shown much survival benefit. Microwave ablation is a well established and safe local ablative method for liver tumors and microwave ablation for locally advanced pancreatic tumors has been extensively used around the world. This is our largest series of microwave ablation in 15 patients with locally advanced pancreatic head carcinoma. The aim of this study was to evaluate the safety, efficacy, feasibility and complications of microwave ablation in unresectable locally advanced pancreatic carcinoma. METHODOLOGY: In total, 15 patients, from January 2004 to December 2006, were included in this study all having locally advanced pancreatic tumors which were found to be unresectable on radiological evaluation. The 15 patients (10 male and 5 female) with a mean age of 67 years were subjected to open microwave ablation after laparotomy and additional palliative procedure like biliary bypass (end-to-side hepaticojejunostomy) and gastric obstruction bypass by antecolic gastrojejunostomy was performed in 6 patients. The location of tumor was predominantly in the head and/or uncinate portion of the pancreas (n=12) and head and body (n=3). The average size of tumor was 6cm (range 4-8cm) and almost all had major regional vascular invasion on CT or MR angiogram. All tumors were histologically proven before the procedure by core needle and frozen section biopsy. Patients with distant metastasis were not included in this study. RESULTS: In all 15 patients, partial necrosis was achieved. There was no major procedure-related morbidity or mortality. Minor complications were seen in 6 out of 15 patients, mild pancreatitis (2), asymptomatic hyperamylasia (2), pancreatic ascites (1), and minor bleeding (1). All patients had close follow-up and the longest surviving patient had a follow-up of 22 months. CONCLUSIONS: Microwave ablation is a beneficial therapy as a local effective procedure which is feasible and safe with acceptable minor complications in a locally advanced pancreatic tumor which can be used as part of a palliative or multimodality treatment, however, further long-term and properly designed studies are required to prove its usefulness in achieving survival benefit.     

Intraoperative and conformal external-beam radiation therapy in patients with locally advanced pancreatic carcinoma; results from a feasibility phase II study

BACKGROUND/AIMS: Chemoradiation therapy is widely indicated to patients with locally advanced pancreatic carcinoma, though the capability of radiotherapy alone is not assessed enough. The purpose of this study is to clarify the efficacy and safety of a more intensive radiotherapy for those patients. METHODOLOGY: Fifteen patients were enrolled in a feasible phase II study of treatment with intraoperative radiation therapy (25 Gy), followed by conformal external-beam radiation therapy (40 Gy in 20 fractions, 5 times/week). The antitumor effect was evaluated on the early phase of dynamic computed tomography image. RESULTS: The full irradiation dose was feasible in 12 of 15 patients. The overall response rate was 40% (1 complete and 5 partial responses). Grade 3 toxicity was observed in 2 patients (13%) with nausea/vomiting or anorexia. One patient developed gastric ulcer and died of gastrointestinal bleeding 12 months after intraoperative radiation therapy. The median survival time was 11.1 months, and the 2-year survival rates were 13%. Survival for more than 2 years was observed in 2 of the 6 responders. CONCLUSIONS: The above radiotherapy is considered to be active for the locally advanced pancreatic cancer with acceptable toxicity, when the gastrointestinal tract is excluded from the radiation field. This should be further assessed in late phase II studies involving a large number of patients.     

Salvage Pancreaticoduodenectomy After Complete Response to Chemoradiotherapy for a Previously Unresectable Pancreatic Adenosquamous Carcinoma: A Case Report

Pancreatic cancer is known for its typically late presentation and poor survival rates, with overall 5-year survival of less than 5%. The role of chemotherapy alone or with radiotherapy in the management of locally advanced tumors continues to be an area of debate.We report a case of locally advanced, pancreatic adenosquamous carcinoma that was initially deemed unresectable intraoperatively. Nonetheless, the tumor was resected after radiological response to gemcitabine-capecitabine chemoradiotherapy regimen similar to the Selective Chemoradiation in Advanced LOcalised Pancreatic cancer trial. Histological examination revealed complete pathological response with extensive fibrosis (ypT0 N0). On 12-month follow-up CT, a single liver lesion in the left lateral segment was identified and confirmed to be a metastasis with cytological diagnosis via EUS and FNA. The disease remained stable and confined to the solitary hepatic metastasis after further gemcitabine chemotherapy. Therefore, a further successful resection was performed.The 2 main strategies for the management of locally advanced unresectable pancreatic cancer are chemotherapy induction followed by consolidation chemoradiotherapy or chemotherapy alone, with conflicting published evidence. Evidence for the optimal management of the rare histological type of adenosquamous carcinoma is scant. We present a case of such tumor with a complete pathological response to chemoradiotherapy. The results of future studies in the area are eagerly awaited.     

Surgery for local recurrence of rectal carcinoma

PURPOSE: This study was designed to evaluate results, especially mortality and morbidity, of surgical resection with curative intent for patients with a local recurrence of rectal cancer, in combination with radiotherapy. METHODS: Consecutive medical records of 163 patients with local recurrence of rectal carcinoma after previous “curative” therapy for primary rectal cancer were reviewed. Although 35 patients had an exploratory laparotomy, only 27 had local recurrence amendable to resection (6 irresectable locoregional recurrences and 2 distant metastases found at laparotomy). Twenty-one patients received radiotherapy. There was no perioperative mortality. Median follow-up time was 42 (range, 22–92) months. RESULTS: Local rerecurrence occurred in 16 (59 percent) patients. Ten patients are alive, of whom nine have good local control. Estimated five-year survival (Kaplan-Meier) is 20 percent. Survival was significantly better in patients without a second recurrence, but radicality of the resection was not influential. Good local control could be obtained in 12 (44 percent) patients, and 1 patient is living with symptoms. CONCLUSIONS: In selected patients with local recurrence of rectal carcinoma, reoperation with irradiation may result in good palliation and possibly cure.     

Phase I Trial of Gemcitabine Dose Escalation with Concurrent Radiotherapy for Patients with Locally Advanced Pancreatic Cancer

Aim: The safety and efficacy, and the dose-limiting toxicity (DLT) of the chemotherapeutic agent gemcitabine administered in conjunction with radiotherapy in patients with locally advanced pancreatic cancer are not yet established. Here, we evaluated the safety and efficacy, DLT, and maximum tolerated dose of gemcitabine with concurrent radiotherapy in patients with unresectable locally advanced pancreatic cancer. Tumor response and time to progression were also assessed. Patients and Methods: Patients with previously untreated pancreatic cancer (n = 12) received gemcitabine intravenously on days 1, 8, and 15. Concurrent radiation therapy was initiated on day 1 (40 Gy in 2 Gy/day × 20 fractions, days 1–5, 8–12, 15–19, 22–26). Patients received limited-field irradiation with three-dimensional radiotherapy. Dose escalation included dose levels 1–3 (gemcitabine 400, 600, and 800 mg/m²). Results: No patient developed DLT in this study. Of the 12 patients, there were 11 sustained responses, 0 partial responses, and 1 progressive disease. Two patients with a sustained response underwent surgery after re-evaluation. The median progression-free survival was 8 months, not including the patients that underwent surgery. Conclusion: Weekly gemcitabine at a dose of 800 mg/m² with concurrent radiation therapy in patients with locally advanced pancreatic cancer was well tolerated.     

Modified extended distal pancreatectomy for carcinoma of body and tail of pancreas

The prognosis of carcinoma in the body and tail of the pancreas is disappointing due to the low rate of resectability, since it is usually presented at an advanced stage with local invasion of adjacent major vessels. However, the postoperative survival, if resectable, is similar to carcinoma of the pancreatic head. Aggressive approach, by applying extended distal pancreatectomy with the resection of the celiac axis, may increase the resectability but promote the potential risk of hepatic dysfunction and biliary necrosis after the sudden interruption of the common hepatic artery. We modified the procedure by reanastomosis between the stump of the celiac axis and common hepatic artery without vascular graft to manage a 50-year-old woman with locally advanced carcinoma of the body and tail of pancreas. She had 2 years of disease-free survival. This modified extended pancreatectomy may be a feasible and safer procedure.     

Phase II study of cisplatin combined with weekly gemcitabine in the treatment of patients with metastatic pancreatic carcinoma.

BACKGROUND/AIMS: Combination therapy of gemcitabine and cisplatin has been reported as an effective regimen for advanced pancreatic cancer. However, the toxicity and synergism are known to depend on the schedule of cisplatin. A phase II study was undertaken to determine the efficacy of a single dose of cisplatin in combination with weekly gemcitabine in patients with metastatic pancreatic carcinoma. METHODS: Patients with measurable, metastatic pancreatic carcinoma, not locally advanced diseases, were included. The patients were treated with a combination of gemcitabine 1,000 mg/m(2) i.v. over 30 min administered on days 1, 8, and 15 of each cycle and cisplatin 75 mg/m(2) i.v. administered 6 h after gemcitabine infusion on day 1 with adequate prehydration. Response and toxicity were assessed according to World Health Organization criteria. RESULTS: A total of 52 patients, 5 with recurrent disease after curative operation, were enrolled from January 2000 to March 2004. The objective response rate was 16 of 52 patients (1 complete response and 15 partial response). Disease stabilization was seen in 10 patients (20.8%). The median survival was 11.8 months (95% CI, 10.7-13.0 months), with 76.1% of patients alive at 6 months and 50% alive at 12 months. The median time to progression was 6.1 months (95% CI, 4.16-7.98 months). Major toxicity profiles were thrombocytopenia and neutropenia. CONCLUSIONS: The modified regimen of a single dose of cisplatin per cycle in combination with weekly gemcitabine appeared to have a more favorable therapeutic index and comparable toxicity profiles.     

Delayed aortic rupture after radiochemotherapy and esophagectomy for esophageal cancer

SUMMARY Spontaneous rupture of major vessels is a known though rare complication in treatment of patients with esophageal cancer, but its pathophysiology is not very well understood. We herein report about the sudden death of a 42‐year‐old man due to spontaneous aortic rupture, 11 days after transthoracic esophagectomy. Because of a locally advanced squamous cell carcinoma of the distal esophagus, which was considered irresectable at the time of presentation, the patient had received one course of chemotherapy followed by synchronous chemoradiation (60 Gy, 5‐fluorouracil and cisplatin) prior to surgery. We discuss the patho‐anatomic findings of the postmortem examination concerning alterations of the aortic wall and the potential correlations with aggressive radiochemotherapy protocols.     

Complete Closure of Cancer-Related Anovaginal and Anoperineal Fistulas in Locally Advanced Anal Canal Carcinomas by Upfront Intra-Arterial Chemotherapy Followed by Combined Radiochemotherapy: Report of Two Cases

Purpose Cancer-related fistulas are a major problem in locally advanced anal canal carcinoma, because conservative radiochemotherapy may not be recommended in this setting. Therefore, it is usually recommended to proceed to an abdominoperineal resection with definitive colostomy in the presence of such lesions. Methods Because chemotherapy can lead to closure of cancer-related fistulas and local intra-arterial chemotherapy is effective in locally advanced anal canal cancer, we treated two anal canal carcinoma patients presenting with cancer-related fistulas with upfront intra-arterial chemotherapy followed by radiochemotherapy, leading to complete closure of fistulas. Results Both patients are free of colostomy and in complete remission after more than four years of follow-up. Conclusions This conservative approach combining local intra-arterial chemotherapy and standard radiochemotherapy is feasible and should be considered in the management of such locally advanced anal canal carcinoma. Reprints are not available.     

Preliminary experience of helical tomotherapy for locally advanced pancreatic cancer

Radiotherapy for locally advanced pancreatic cancer is technically difficult and frequently associated with high- grade digestive toxicity. Helical tomotherapy （HT） is a new irradiation modality that combines megavoltage computed tomography imaging for patient positioning with intensity-modulated fan-beam radiotherapy. Its recent availability opens new fields of exploration for pancreatic radiotherapy as a result of its ability to tailor very well-defined dose distributions around the target volumes. Here, we report the use of HT in two patients with locally advanced pancreatic cancer. Doses to the bowel, kidneys and liver were reduced significantly, which allowed for excellent treatment tolerance without any high-grade adverse effects in either patient.