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。
Objective To study the risk factors for contralateral breast cancer (CBC) in women after regular treatment of the primary breast cancer. Methods Between January 1997 to December 2002, the clinical data of 340 breast cancer patients at our institution were retrospectively analyzed. In all the patients a detailed analysis was carried out with respect to age, operation type, radiation therapy technique and dose, the use of chemotherapy or hormone therapy, and other clinicopathologic characteristics. The KaplanMeier method was used to estimate the actuarial rate of CBC. The Cox proportional hazard regression model was used to estimate the relative risk factors of CBC. Results Fourteen cases were diagnosed to be CBC, thus overall incidence of CBC was 4.1%. Ten-year CBC incidence (2.7%) was higher than 5-year incidence of CBC (1.4%). Univariate analysis showed that the risk factors of CBC at 5-year and 10-year included: ≤45 years old, medullary carcinoma, family history of breast cancer and being taken without endocrine therapy (P＜0.05), while chemotherapy and radiotherapy were not risk factors of CBC (P＞0.05). Mutivariate analysis showed that ≤ 45 years old and being internal breast radiotherapy were independent risk factors of CBC at 5-year and 10-year (P＜0.05). Conclusions CBC may occur in these primary breast cancer patients with age ≤45 years old, medullary carcinoma, family history of breast cancer. In order to reduce the incidence of CBC, endocrine therapy rather than internal breast radiotherapy should be performed in early breast cancer patients.
Objective To overview the systematic reviews of the effectiveness and safety of the charged-particle radiation therapy. Methods Databases including CNKI, WanFang Data, PubMed, and EMbase were electronically searched from January 2007 to November 2020. Two investigators independently screened literature, extracted data, and assessed the quality of the included studies by AMSTAR 2, and then reported results through a narrative synthesis of outcomes. Results A total of 6 systematic reviews were identified. One systematic review demonstrated moderate quality and the other 5 demonstrated critically low quality. The charged-particle radiation therapy had a wide range of applications. Its effectiveness was superior to traditional radiotherapy methods on various types of tumors in various regions of the body, with acceptable side effects. Specifically, the effectiveness and safety outcomes of carbon ion radiotherapy was superior to those of proton radiotherapy. Conclusions Current evidence shows that the charged-particle radiation therapy has superior effectiveness and limited toxicity, though the studies are of relatively low quality. High quality and larger sample size researches are required in the future.
Objective To evaluate the effect of postmastectomy radiotherapy(PMRT)on the rate of loco-regional recurrence and survival for breast cancer patients undergoing radical mastectomy with one to three positive lymph nodes. Methods The database of Pubmed, Embase, EBM Reviews-Cochrane Central Register of Controlled Trials, CBM, CNKI, VIP, and Chinese Cancer were searched. All randomized controlled trials about postmastectomy radiotherapy on breast cancer patients with 1-3 positive lymph nodes were considered for inclusion. Revman 5.3 was used in the meta analysis. Results Four trials enrolled 1 254 breast cancer women with 1-3 positive lymph nodes were included. The studies were high quality according to the evaluations of the quality criteria. After 10 to 20 years follow-up, the results showed that, 460 patients were analyzed in the result of loco-regional recurrence, the hazard ratio (HR) was 0.23, 95%CI (0.15, 0.37), the result showed statistical difference (P＜0.000 01), and the heterogeneity was existed (P=0.09,I2=59%). One thousand two hundred and fifty-four patients were analyzed in the result of overall survival, theHR was 0.82, 95%CI (0.71, 0.93), the result showed statistical difference (P=0.002 ), and there did not existed heterogeneity (P=0.65,I2=0%). Four hundred and sixty patients were analyzed in the result of metastasis-free survival, theHR was 0.71, 95%CI (0.56, 0.90), the result showed statistical difference (P=0.005), and there did not existed heterogeneity (P=0.63,I2=0%). Nine hundred and seventy-seven patients were analyzed in the result of disease free survival, theHR was 0.74, 95%CI (0.66, 0.85), the result showed statistical difference (P＜0.000 01), and there did not existed heterogeneity (P=0.49,I2=0%). Conclusion Through this systematic review, we consider that postmastectomy radiotherapy could reduce the loco-regional recurrence and increase the overall survival for long-term.
Image-guided radiation therapy using magnetic resonance imaging (MRI) is a new technology that has been widely studied and developed in recent years. The technology combines the advantages of MRI imaging, and can offer online real-time tracking of tumor and adjacent organs at risk, as well as real-time optimization of radiotherapy plan. In order to provide a comprehensive understanding of this technology, and to grasp the international development and trends in this field, this paper reviews and summarizes related researches, so as to make the researchers and clinical personnel in this field to understand recent status of this technology, and carry out corresponding researches. This paper summarizes the advantages of MRI and the research progress of MRI linear accelerator (MR-Linac), online guidance, adaptive optimization, and dosimetry-related research. Possible development direction of these technologies in the future is also discussed. It is expected that this review can provide a certain reference value for clinician and related researchers to understand the research progress in the field.
Objective To investigate the effect of iodine-125 on inhibiting breast cancer growth and to explore its possible mechanism. Methods The animal model of the MCF-7 tumor was established firstly through injection of the cells into nude mice. The animals were divided into two groups before the implantation of the iodine-125 granule into the tumor mass: control group (n=40, to implant no-load seeds, non-iodine-125 radioelement) and experimental group 〔n=40, to implant iodine-125 seeds (1.48×107 Bq) when the length of tumor was 8-10 mm〕. The width and length of tumor, in order to calculate the volume, were measured every three days to observe tumor growth curve and to calculate the rate of the tumor inhibition. When the length of tumor was 15-20 mm in the control group, 30 nude mice were killed in every group to detect the weight of tumor and histopathological changes. Other ten nude mice of each group were remained to be observed the national life span and survival rate for 90 days. Results Within 90 days, the average survival time in control group and experimental group were significantly different (56.2 d vs. 74.8 d, P＜0.05). In control group the growth curve was continuously elevated, while experimental group showed a low flat curve. With iodine-125 treatment, the tumor growth decreased in experimental group with tumor inhibition rate 55.21%. The average tumor weight in control group and experimental group was (3.26±0.39) g and (1.46±0.17) g (t′=22.8962, P＜0.05). As compared with control group, under light microscope, the number of cancer cells was less, nuclear debris increased, and cancer structure was not obvious in experimental group. Conclusion This study suggests that iodine-125 seed may inhibit the growth of breast cancer, which may be involved in direct radiation breakdown of tumor cells or induction of apoptosis and inhabitation of tumor angiogenesis.
ObjectiveTo assess the cosmetic outcomes and adverse events of MammoSite balloon brachytherapy for Accelerated Partial Breast Irradiation following breast-conserving surgery for patients with early stage breast cancer. MethodsWe searched PubMed, EMbase, Chinese Biomedical Database, Chinese Studies Online, China Journal Full-text Database up to March 2016, to collect clinical trials about MammoSite balloon brachytherapy following breast-conserving surgery for early stage breast cancer. And meta-analyses were performed by OpenMeta and Stata softwares. ResultsTwenty trials involving 3 796 patients were enrolled. The single arm meta-analysis results showed that:the cosmetic results were rated as excellent to good in 93% (95%CI 0.91 to 0.96), and the 5-year incidence of ipsilateral breast tumor recurrence (IBTR) was 3% (95%CI 0.020 to 0.040). ConclusionTo carry out the conclusion above, we still need controlled trials, especially randomized controlled trials (RCTs) to prompt further verification.
目的探讨甲状腺肉瘤的诊断与治疗。 方法回顾性分析2008年1月至2013年8月期间贵阳医学院附属医院甲状腺外科和贵州肿瘤医院甲状腺外科收治的5例甲状腺肉瘤患者的临床资料。 结果5例患者均行根治性手术，3例行术后化疗及放疗。术后均未发生声音嘶哑、呼吸困难、呛咳、肺部感染等并发症，切口均甲级愈合。经病理学免疫组化检查，具体分型为甲状腺组织细胞肉瘤1例，甲状腺血管肉瘤2例，甲状腺平滑肌肉瘤1例，甲状腺未分化肉瘤1例；波形蛋白（Vimentin）阳性5例，角蛋白（CK）阳性2例，平滑肌肌动蛋白（SMA）、结蛋白（Des）及S-100各阳性1例，甲状腺球蛋白（TG）、上皮膜抗原（EMA）、甲状腺转录因子（TTF）及降钙素均为阴性。术后5例患者均经电话随访，随访时间3～9个月，中位数为6个月。随访期间，3例患者因复发和转移而死亡；余2例仍在化疗及放疗中，无复发及转移。 结论甲状腺肉瘤的恶性程度高，宜采用以手术为主的综合治疗方案。
Objective To evaluate the clinical efficacy and safety of hyperthermia combined with radiotherapy and chemotherapy (HRCT) for non-small cell lung cancer (NSCLC), so as to provide references for further clinical practice and research. Methods The databases such as The Cochrane Library, PubMed, EMbase, CBM, CNKI, VIP and WanFang Data were searched on computer from the date of their establishment to May 1st of 2011, and other sources as supplied were also retrieved to collect all the relevant randomized controlled trials (RCTs) on comparing HRCT with non-HRCT. The quality of the included trials was assessed according to the Cochrane Handbook 5.1 for Systematic Review and the features of this study as well. Meta-analyses were conducted by using RevMan 5.1 software. Results A total of eight RCTs involving 546 patients were included. The results of meta-analyses showed that: a) Total effective rate: The total effective rate of HRCT was higher than other non-HRCT therapies, and there were significant differences in HRCT compared with radio-chemotherapy, hyperthermia plus chemotherapy, and pure chemotherapy, the OR and 95%CI were 2.05 (1.18, 3.56), 3.41 (1.12, 10.38), and 6.11 (1.20, 31.16), respectively; and b) Safety evaluation: The incidence rates of radiation pneumonitis, radiation esophagitis and granulocytopenia were all lower in the HRCT group than that in the radio-chemotherapy group, but the significant differences were only found in the incidence rate of granulocytopenia (OR=0.34 (0.19, 0.59). Conclusion Compared with other therapies, HRCT tends to improve the clinical efficacy and safety for NSCLC, but this result needs to be proved by more clinical trials. HRCT is superior to the routine radio-chemotherapy in both efficacy and safety, but the relevant evidence for proving its long-term efficacy and safety is still required.
ObjectiveTo understand the biological behavior of primary squamous cell carcinoma of thyroid (PSCCT), and provide references for its clinical diagnosis and treatment.MethodThe latest domestic and foreign reports of PSCCT were collected and analyzed.ResultsIn the diagnosis of PSCCT, the possibility of metastasis of squamous cell carcinoma to thyroid should be excluded. It often presented with hoarseness, local obstruction, and the median survival time was about 12 months. The treatment mainly relies on complete surgical resection.ConclusionPrimary squamous cell carcinoma of thyroid is a rare disease with rapid disease progression, poor overall prognosis and limited therapeutic options.