探讨立体定向囊内放射治疗囊性和囊实性颅咽管瘤的方法和疗效。方法:对12例囊性和囊实性颅咽管瘤的囊性部分行CT、MRI 引导立体定向吸除囊液、注入胶体磷酸铬,待瘤囊缩小远离视神经等重要结构后,施行伽玛刀治疗。结果:全部病例经手术排出囊液后临床症状迅速改善。经囊内放疗后2-36个月随访12例患者,CT、MRI扫描显示5例患者瘤囊持续消失,临床症状消失,恢复正常的生活和学习;5例患者肿瘤显著缩小,症状持续改善;2例肿瘤无明显改变;无死亡病例。结论:CT、MRI引导立体定向放射治疗囊性颅咽管瘤安全、有效。
【摘要】 目的 探讨三维适形放疗(3DCRT)联合介入栓塞化疗(TACE)治疗Ⅲ、Ⅳ期原发性肝癌的方法和临床价值。 方法 回顾性总结2006年6月-2008年12月采用3DCRT联合TACE治疗原发性肝癌的临床资料40例。 结果 3DCRT联合TACE治疗Ⅲ、Ⅳ期原发性肝癌有效率为85%。0.5、1、2年局部控制率分别为92%、70%、52%。0.5、1、2年生存率分别为75%、46%、30%，治疗不良反应轻微。 结论 3DCRT联合TACE能提高原发性肝癌患者生活质量，延长生存期,是治疗中晚期原发性肝癌的有效治疗方法之一。【Abstract】 Objective To investigate the application and clinical value of three-dimensional conformal radiation therapy (3DCRT) combined with transcatheter arterial chemoembolization (TACE) on stage Ⅲ and Ⅳ primary hepatic carcinoma. Methods A Total of 40 cases of stage Ⅲ and Ⅳ primary hepatic carcinoma treated by 3DCRT combined with TACE from June 2006 to December 2008 were analyzed retrospectively. Results The response rate was 85%. The 0.5-, 1-, and 2-year local response rates were 92%, 70%, and 52%, and the 0.5-, 1-, and 2-year survival rates were 75%, 46%, and 30%, respectively. The adverse reactions of radiotherapy were tolerable. Conclusion 3DCRT combined with TACE could improve prognosis of stage Ⅲ and Ⅳprimary hepatic carcinoma.
ObjectiveTo explore the surgical treatment of deep chest wall infection, improve the cure rate and reduce the recurrence rate.MethodsThe clinical data of 655 patients with deep chest wall infection treated in Yanda Hospital and Beijing Royal Integrative Medicine Hospital from June 2015 to June 2020 were retrospectively analyzed. There were 450 males and 205 females, aged 55.6±12.8 years. There were 8 patients with chest wall infection after tumor necrosis, 15 patients after radiotherapy and 632 patients after thoracotomy (612 patients after cardiovascular surgery and 20 patients after general thoracic surgery). Among them, 649 patients underwent debridement and reconstruction of chest wall defect with muscle flap.ResultsThe average operation time was 95±65 min, the average intraoperative blood loss was 180±100 mL, and the average postoperative hospital stay was 13±6 d. Of the 649 patients who underwent muscle flap reconstruction after debridement, 597 patients recovered within 2 weeks, and the primary wound healing rate was 94.4%. Twenty-three (3.5%) patients died. The median follow-up time was 25 (2-40) months. Among the remaining 632 patients, 20 recurred, with a recurrence rate of 3.1% (20/632).ConclusionPedicled muscle flap after thorough debridement of deep chest wall infection is one of the best methods to repair chest wall defect with pedicled muscle flap.
Objective The objective of this study is to find individualized, evidence-based treatment for a patientwith extensive small cell lung cancer, malignant pleural effusion, and liver metastasis.Methods According to the PICO (patient intervention comparison outcome) principle, evidence was collected and critically assessed. The patient’s preference was also taken into consideration in the decision making process. Results We included 10 randomized controlled trials, 13 systematic reviews and meta-analyses, and three clinical guidelines. The evidence indicated that chemotherapeutic treatment prolongs survival in patients with extensive small cell lung cancer and AiDi injections could relieve adverse effects caused by chemotherapy or radiotherapy. Cisplatin and etoposide are considered major standard cytotoxic drugs for small cell lung cancer. We drained the pleural cavity and infused Bleomycin into the pleural cavity. We also used an EP regimen of chemotherapy after the patient’s condition had improved. This patient survived longer than the average survival time for small cell lung cancer patients and has enjoyed a higher quality of life. Conclusion Chemotherapy is the main medical treatment for patients with extensive small cell lung cancer, backed up by symptomatic treatment and supportive care. Prophylactic cranial irradiation decreases brain metastases incidence and improves survival in complete response small cell lung cancer patients.
ObjectiveTo systematically evaluate the efficacy of adjuvant radiotherapy after thymoma resection. MethodsThe PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang, VIP, CNKI databases were systematically searched to find relevant literature comparing the efficacy and effectiveness of thymoma resection and thymoma resection+postoperative radiation therapy (PORT) for treating thymoma published from inception to January 2024. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of included retrospective studies, and Review Manager 5.4 software was used to perform meta-analysis. ResultsA total of 23 articles were included, all of which were retrospective studies. There were a total of 13742 patients, including 6980 patients in the simple surgery group, with 3321 males and 3659 females, and an average age of 54.08 years; 6762 patients in the surgery+PORT group, with 3385 males and 3377 females, and an average age of 53.76 years. The NOS scores of the included literature were all≥7 points. The results of the meta-analysis showed that compared with the simple surgery group, the surgery+PORT group had higher 1-year overall survival rate [OR=0.32, 95%CI (0.25, 0.42), P<0.001], 3-year overall survival rate [OR=0.55, 95%CI (0.48, 0.64), P<0.001], 5-year overall survival rate [OR=0.66, 95%CI (0.58, 0.75), P<0.001], 10-year overall survival rate [OR=0.71, 95%CI (0.57, 0.88), P=0.002], 1-year disease-free survival rate [OR=0.47, 95%CI (0.23, 0.93), P=0.030], 5-year disease-free survival rate [OR=0.61, 95%CI (0.45, 0.84), P=0.003], 3-year disease-specific survival rate [OR=0.44, 95%CI (0.35, 0.55), P<0.001], 5-year disease-specific survival rate [OR=0.53, 95%CI (0.44, 0.63), P<0.001] and 10-year disease-specific survival rate [OR=0.53, 95%CI (0.35, 0.82), P=0.004]. But there was no statistically significant difference between the two groups in terms of 3-year disease-free survival rate [OR=0.86, 95%CI (0.61, 1.22), P=0.400], 10-year disease-free survival rate [OR=0.70, 95%CI (0.47, 1.05), P=0.080] and 1-year disease-specific survival rate [OR=0.83, 95%CI (0.55, 1.26), P=0.380]. ConclusionPORT after thymoma resection has more advantages than simple surgical treatment in terms of 1-, 3-, 5-, and 10-year overall survival, 1- and 5-year disease-free survival, and 3-, 5- and 10-year disease-specific survival.
Objective To find individualized evidence-based treatments for a patient with lower rectal cancer. Methods Based on the clinical questions raised, evidence was collected and critically assessed. Patient preferences and physician clinical experience were also taken into consideration in the decision-making treatment. Results Twenty-four systematic reviews or meta analyses and 1 clinical guideline were included. The evidence showed that preoperative chemoradio- therapy reduces risk of local recurrence and death from rectal cancer compared to preoperative radiotherapy alone. Preoperative combined chemoradiotherapy, enhanced pathological response and improved local control in the resectable stage II and III rectal cancer. Preoperative chemoradiotherapy reduced the risk of local recurrence as compared with postoperative chemoradiotherapy. Postoperative radiotherapy alone did not improve survival for the patients with resected stage II and stage III rectal cancer, whereas either chemotherapy alone or combined chemotherapy and radiotherapy improved survival in comparison with observation. As compared with conventional radical surgery, total mesorectum excision (TME) resulted in lower postoperative local recurrence rate and higher survival rate. No significant differences in terms of disease-free survival rate, local recurrence rate, mortality, and morbidity were found between laparoscopic and open total mesorectal excision. Conclusion The patients with lower rectal cancer might benefit from preoperative chemoradiotherapy, postoperative chemotherapy, and chemoradiotherapy. TME is the standard rectal cancer surgery. However, long-term prognostic benefits need to be confirmed by further follow-up.
ObjectiveThe research progress of new multifunctional bone cement in bone tumor therapy in recent years was reviewed, in order to provide help for the future research of anti-tumor bone cement. Methods The related literature on the treatment of bone tumors with new multifunctional bone cement at home and abroad in recent years was extensively reviewed and summarized. Results The new multifunctional bone cements include those with the functions of photothermotherapy, magnetic thermotherapy, chemoradiotherapy, and antibacterial after operation, which are discussed from the aspects of anti-tumor, drug controlled release, and cytotoxicity. Controlled drug release has been achieved in multifunctional bone cements by adjusting heat and pH or incorporating particles such as chitosan oligosaccharides and γ-cyclodextrin. At present, multifunctional bone cement with hyperthermia, radiotherapy, and chemotherapy has effectively inhibited the local recurrence and distant metastasis of bone tumors. Broadening the application of bone cement for photothermal and magnetic thermal therapy to deeper bone tumors, investigating more precise controlled release of drug-loaded bone cement, and introducing nanoparticles with both thermal conversion and intrinsic enzymatic activities into bone cement for synergistic anti-tumor therapy are promising research directions. ConclusionThe new multifunctional bone cement inhibits bone tumor cells, promotes new bone formation in bone defects, and prevents incision infection after tumor resection. Certain progress has been made in anti-tumor, antibacterial, drug-controlled release, and reduction of cytotoxicity. Expanding the deeper application range of the new multifunctional bone cement, verifying the safety in clinical application, and focusing on the individualized treatment of the new multifunctional bone cement are the problems that need to be solved in the future.
Objective To evaluate the efficacy and side effect of non-conventional fractionated radiotherapy for head and neck cancer.Methods Trials were identified by searching CENTRAL, MEDLINE, EMBASE, Chinese Biological Medicine Database (CBMdisc) and Chinese VIP Database. We handresearched the data from 10 kinds of important Chinese journals. Two reviewers assessed and extracted the studies. The following primary outcomes were assessed: complete relief (CR), overall survival (OS), acute side effect and late side effect. Results Twenty-three trials involving 8 411 patients were included. Thirteen trials were of good quality, and the rest were of poor quality. Meta-analysis of these trials showed that: (1) non-conventional fractionated radiotherapy vs conventional fractionated radiotherapy: ① Only S-HART and CAIR resulted in higher CR, RR=1.21 (95%CI 1.02 to 1.44), 3.31 (95%CI 1.16 to 9.42), respectively; ② Only HRT could improve 2-year OS (RR=1.32, 95%CI 1.13 to 1.54), but this difference wasn’t found in 5-year follow up; ③ Most of the non-conventional fractionated radiotherapy could increase acute side effects, but not the late ones; (2) non-conventional fractionated radiotherapy combined with concurrent chemotherapy vs non-conventional fractionated radiotherapy: ① Only C-HRT resulted in higher CR (RR=1.58, 95%CI 1.18 to 2.11); ② Higher 2-year OS could be gained when combined with chemotherapy (RR=1.35, 95%CI 1.18 to 1.54), and only C-HRT resulted in higher 5-year OS (RR=1.57, 95%CI 1.19 to 2.07). ③ Acute and late side effects of radiotherapy would not increase when combined with chemotherapy. Conclusion It can not be concluded that non-conventional fractionated radiotherapy can improve the CR and OS of head and neck cancer, for a small number of patients, but it will get effect when combined with concurrent chemotherapy, and would not increase acute or late side effects. The effects of HRT and C-HRT should be cared specially.
Objective To evaluate the influence of resection status, pathological type, pathological stage and postoperative adjuvant therapy on prognosis of surgically treated thymic carcinoma. Methods In this retrospective study, 56 patients with surgically treated thymic carcinoma in the Department of Thoracic Surgery, Peking Union Medical College Hospital from January 2005 to December 2015 were enrolled. There were 30 males and 26 females aged 52.1±11.5 years ranging from 22 to 81 years. The survival curve was performed by Kaplan-Meier method. The prognostic factors affecting overall survival (OS) and disease-free survival (DFS) were analyzed by one-way analysis of variance (ANOVA). Results R0 resection was performed in 37 patients (67.9%), and other resections in 19 (32.1%); 13 patients suffered thymic carcinoma with Masaoka stage Ⅰ-Ⅱ, 26 Ⅲ, and 17 Ⅳ. Low-grade thymic carcinoma was found in 42 patients, and high-grade in 14. Postoperative radiotherapy, chemotherapy and chemoradiotherapy were performed on 17, 12 and 18 patients respectively and 9 patients were untreated. Forty-one patients was followed up for 1 to 10 years, and the follow-up rate was 73%. The 1-, 3- and 5-year OS rates were 93%, 74% and 61%, respectively. Resection status and pathological stage affected OS. Postoperative radiotherapy after R0 resection affected DFS, but did not affect OS. Conclusion Most patients with thymic carcinoma after surgery can survive for a long period, and R0 resection is the most important prognostic factor of thymic carcinoma. Postoperative radiotherapy after R0 resection in patients with Masaoka stage Ⅱ-Ⅲ is recommended.
We reported three cases of stageⅢ/N2 non-small cell lung cancer (NSCLC) treated with neoadjuvant immunotherapy and stereotactic body radiation therapy (SBRT) in our hospital, including 2 males and 1 female with a mean age of 65.7 years. The patients received two doses of the programmed cell death protein-1 inhibitor toripalimab after 1 week of SBRT. Thereafter, surgery was planned 4-6 weeks after the second dose. One patient achieved pathologic complete response, one achieved major pathologic response (MPR), and one did not achieve MPR with 20% residual tumor. There were few side effects of toripalimab combined with SBRT as a neoadjuvant treatment, and the treatment did not cause a delay of surgery.