榄香烯乳联合放疗治疗肺癌脑转移40例疗效分析

目的观察榄香烯乳联合放疗对肺癌脑转移治疗的疗效。方法选择我院2004年5月～2005年7月期间经病理组织学或细胞学确诊为肺癌患者经增强脑CT证实脑转移的病例40例,KPS评分70以上,年龄32～80岁之间,脑放疗同时应用榄香烯第1～5天400mg(如无脑水肿表现,在第1天用榄香烯;其他多在放疗后5～7天水肿期过后,患者水肿症状如头痛,恶心、呕吐减轻,再用榄香烯)经深静脉滴入,21天为一个周期,脑放疗选择适形立体照射,脑转移灶1～3个者,全脑放疗40Gy后,缩野放疗至总量60Gy;脑转移灶>3个者,全脑放疗至总量40Gy。评价近期的有效率及生存率与生活质量。结果治疗后80%患者的神经症状得以改善,对脑转移灶的客观有效率为67.5%,对肺原发灶的有效率为40%。完全缓解(CR)2例,部分缓解(PR)25例,稳定(SD)9例,进展(PD)4例。一年生存率为72.5%,二年生存率为35%,三年生存率为2.5%。结论榄香烯乳联合放疗治疗肺癌脑转移疗效好,生存率高,值得在临床上广泛推广及应用。     

50例手术治疗直肠癌的临床分析

目的探讨手术治疗直肠癌的临床特点。方法回顾性分析我院近6年来收治的50例直肠癌患者的临床资料。结果50例直肠癌患者,保肛手术均获得成功,手术成功率100%。术后出现肛门刺激症状31例,占62.0%,主要表现为大便次数增多、肛门下坠、便意感明显等。对症治疗后1～2个月内症状明显改善,无吻合口瘘及术后并发吻合口狭窄。继续随访6个月～5年,6例患者肝、肺及腹腔广泛转移,死亡4例,5年生存率为92.0%。结论采用保肛手术治疗低位直肠癌临床疗效确切,值得推广使用,但必须以根治肿瘤为首要任务,并严格把握保肛手术的适应证。     

124例早期乳腺癌患者行保乳手术临床疗效分析

目的 观察早期乳腺癌保乳手术的治疗效果。方法 回顾分析2006年8月至2011年4月将I、II期乳腺癌患者共124例随机分为保乳手术组(治疗组60例)和改良根治术组(对照组64例)进行对比观察。采用肿瘤局部扩大切除或象限切除,以及腋淋巴结清扫,术后辅以放疗、化疗或内分泌治疗。残留腺体做阶梯状对缝,以保证乳晕部的隆起。结果 所有患者随访11～51个月,平均37个月。随访所有患者无死亡,无肿瘤局部复发,2例于术后43个月出现肺内转移,3年总存活率100%,局部复发率0%,无瘤生存率98.36%。12例皮肤有放疗后色素沉着,约占9.68%(6/62)。4例出现皮下积液。2组手术出血量、手术时间、住院时间比较差异有非常显著性。并发症发生率、生存率,比较差异无显著性。结论 保乳手术创伤小、并发症少、恢复快、形体改变小,疗效满意,病人心理状态良好,生存质量较高。     

肝炎后肝硬化肺部常见合并症78例临床分析

目的探讨肝硬化患者合并肺部感染和肺水肿的发生因素、临床特点及对肝硬化预后的影响进行分析。方法总结近10年来收治肝炎后肝硬化298例患者中资料完整的78例肝硬化住院患者并发肺部感染、肺水肿的一般资料、临床表现、胸部X线表现及实验室检查和转归情况。结果本文298例肝炎后肝硬化有肺部常见合并症患者78例,其中肺部感染46例,肺水肿32例。78例患者死亡43例,病死率达55.1%。结论肝硬化合并肺部病变后可进一步加重肝功损害,诱发或加重多种并发症,使病情恶化。对肝硬化患者在积极治疗原发病,改善肝功能,提高免疫功能同时早期预防肺部合并症的发生,发现肺部合并症时及时采取有效的处理可望降低病死率,改善预后。     

三维适形放疗和同步化疗治疗非小细胞肺癌的临床研究

目的探讨三维适形放疗(3 DCRT)和同步化疗治疗Ⅲ期非小细胞肺癌的疗效和毒副反应。方法64例Ⅲ期NSCLC患者均采用三维适形放射治疗,单次治疗剂量为400cGy,治疗次数为14次,总剂量为56Gy,18~21d完成;同期采用TP方案化疗,化疗疗程为4～6周期。结果72例患者获得完全随访。肺原发灶总有效率为93.1%;纵隔转移淋巴结总有效率为100.0%;肺鳞癌总有效率为93.5%;肺腺癌总有效率为81.1%。全组患者1、2年局控率分别为63.9%和41.7%;中位生存时间为18.9个月,1、2年生存率分别为76.2%和47.2%。白细胞下降总发生率为95.8%;恶心、呕吐反应为33.3%;Ⅰ、Ⅱ级急性放射性食管炎和放射性肺炎发生率分别为54.2%和12.5%。结论三维适形放疗和化疗同步治疗Ⅲ期非小细胞肺癌,耐受性好,有较好的近期疗效,并能提高1、2、3年生存率。     

脑出血患者院内肺部感染危险因素分析与对策

目的探讨脑出血患者并发院内肺部感染的危险因素,以及采取有效控制措施。方法对我院2007年9月至2009年9月治疗的124例脑出血患者进行院内肺部感染及其危险因素的回顾性分析。结果脑出血并发院内肺部感染32例,院内肺部感染发生率为25.81%。高龄患者、有肺部疾病史、住院时间长、呼吸机的使用、气管插管/切开、吸烟史是院内肺部感染发生的危险因素。结论脑出血患者院内肺部感染发生率高,应引起重视,尽可能把脑出血并发院内肺部感染控制到最低限度。     

三维适形放疗联合HIFU刀治疗胰腺癌的临床观察

目的探讨三维适形局部放疗联合HIFU刀(高强超声聚焦刀)对不能手术切除的胰腺癌患者的疗效及价值。方法 50例胰腺癌患者随机分为2组,综合组25例,采用三维适形放疗的同期给予HIFU刀治疗。放疗开始后每周加做1～2次HIFU刀。单放组25例,单独应用三维适形放疗。2组病人照射剂量相同(50～60Gy,2Gy/次,5次/周)。结果胰腺癌原发灶:总有效率(CR+PR)综合组与单放组分别为48%与24%。疼痛缓解率分别为84%与40%。2组原发灶总有效率及疼痛总缓解率均有统计学差异(P<0.05)。治疗过程中无明显不良反应。结论三维适形放疗联合HIFU刀能控制肿瘤进展,改善生活质量,无明显不良反应,是治疗胰腺癌的较好的姑息治疗方法。     

放疗联合微波热疗治疗晚期颈部淋巴转移癌(附35例报告)

目的探讨放射治疗与微波热疗联合治疗晚期颈部淋巴结转移癌的临床疗效。方法对70例颈部淋巴结转移癌患者随即分成2组,行单纯放疗组35例和放疗加微波热疗组35例,治疗结束后3个月进行疗效评价。结果放疗组CR31.4%(11/35),放疗加热疗组CR51.4%(18/35),经统计学分析,2组间差异有显著性(P<0.05)。放疗组CR+PR65.7%(23/35),放疗加热疗组CR+PR88.6%(31/35),经统计学分析,2组间差异有显著性(P<0.05)。结论微波热疗对放疗有协同增敏作用,二者配合对颈部较淋巴结转移癌的治疗有重要的临床应用价值。     

58例急性胃穿孔的救治体会

目的考察在急性胃穿孔救治中使用的方法及所需注意的问题。方法考察本院2004年6月至2009年6月本院收治的58例急性胃穿孔患者的救治,就其发病原因,医治手段,术后护理及并发症的避免进行回顾性分析。结果本院共收治的58例患者中,1例由于急性胃穿孔并发肺部感染,在手术过程中死亡,其余患者全部完成手术。经过14d的恢复,86.2%(50/58)患者病情得到控制且未发生并发症,另有8例患者发生了并发症,其主要的并发症为腹腔感染(3例),肺部感染(3例),消化道出血(2例)。1例患者由于术后并发腹腔感染死亡。结论很多原因会导致急性胃穿孔,主要的原因为胃溃疡。需要在基层普及胃穿孔的临床知识,以免延误病情,并在初诊的过程中,对患者的体征进行判定,在第一时间内做出合理的处理方法,降低该病的死亡率,促进患者的康复。     

膀胱恶性非上皮性肿瘤的诊治分析

目的探讨膀胱恶性非上皮性肿瘤的临床诊治。方法随机选取来我院进行诊治的膀胱恶性非上皮性肿瘤患者48例,并对其临床资料进行回顾性分析,将结果与膀胱良性肿瘤患者进行对比,观察其临床症状及诊治方法。结果对良性肿瘤患者行膀胱部分切除术后,均恢复良好;膀胱恶性非上皮性肿瘤行膀胱全切除术,术后行放疗或加化疗等措施,2例因转移仅做部分切除,6个月后死亡。结论膀胱恶性非上皮性肿瘤临床病理类型较为复杂,对其进行镜下活检可对病情诊断提供依据,同时,应结合其病理特点辅助放化疗,可对病情的治疗具有一定的临床价值。     

147例肺癌核素骨显像结果分析

目的探讨肺癌骨转移患者骨显像的特点及规律。方法对147例肺癌患者静脉注射99mTc-MDP,3～4h后行全身骨显像。结果147例肺癌患者中骨转移阳性者73例,阳性率为49.7%。其中肺腺癌的阳性率为62.9%,肺鳞癌的阳性率为38.9%,两者骨转移阳性率之间有显著统计学差异(P<0.01)。骨转移的部位以胸部为多见,其次为脊柱、骨盆、肢体和颅骨。结论核素骨显像对于探查肺癌骨转移瘤有很高的灵敏度,肺腺癌较鳞癌易发生骨转移,骨转移的部位以胸部为多见。     

Metformin Protects against Radiation-Induced Acute Effects by Limiting Senescence of Bronchial-Epithelial Cells

Radiation-induced damage to normal lung parenchyma remains a dose-limiting factor in thorax-associated radiotherapy (RT). Severe early and late complications with lungs can increase the risk of morbidity in cancer patients after RT. Herein, senescence of lung epithelial cells following RT-induced cellular stress, or more precisely the respective altered secretory profile, the senescence-associated secretory phenotype (SASP), was suggested as a central process for the initiation and progression of pneumonitis and pulmonary fibrosis. We previously reported that abrogation of certain aspects of the secretome of senescent lung cells, in particular, signaling inhibition of the SASP-factor Ccl2/Mcp1 mediated radioprotection especially by limiting endothelial dysfunction. Here, we investigated the therapeutic potential of a combined metformin treatment to protect normal lung tissue from RT-induced senescence and associated lung injury using a preclinical mouse model of radiation-induced pneumopathy. Metformin treatment efficiently limited RT-induced senescence and SASP expression levels, thereby limiting vascular dysfunctions, namely increased vascular permeability associated with increased extravasation of circulating immune and tumor cells early after irradiation (acute effects). Complementary in vitro studies using normal lung epithelial cell lines confirmed the senescence-limiting effect of metformin following RT finally resulting in radioprotection, while fostering RT-induced cellular stress of cultured malignant epithelial cells accounting for radiosensitization. The radioprotective action of metformin for normal lung tissue without simultaneous protection or preferable radiosensitization of tumor tissue might increase tumor control probabilities and survival because higher radiation doses could be used.     

The radiation crosslinking of poly(vinyl chloride) with trimethylolpropane trimethacrylate. I. Dose dependence and the effects of thermal treatment

The radiation crosslinking of poly(vinyl chloride), PVC, with trimethylolpropane trimethacrylate, TMPTMA, has been examined. The polyfunctional TMPTMA undergoes rapid polymerization incorporating the PVC into a three-dimensional network. The kinetics and mechanism of these crosslinking reactions were studied with particular reference to dose dependence and thermal treatment. The gel was rapidly formed with a TMPTMA polymerization rate greater than that of the PVC grafting reaction. Only 30–40% of the available bonds were used in the initial polymerization. The remaining 60–70% of the double bonds predominantly react in the final stages of crosslinking (80–100% gelation). The macroscopic properties (e.g., solubility, glass transition temperatures, mechanical characteristics, etc.) of the PVC–TMPTMA blend are discussed in terms of the molecular crosslinking mechanism. The effect of thermal treatment, during and after irradiation, on the reaction rates and mechanism is examined.     

Treatment of Brain Metastases of Non-Small Cell Lung Carcinoma

Lung cancer is one of the most common malignant neoplasms. As a result of the disease’s progression, patients may develop metastases to the central nervous system. The prognosis in this location is unfavorable; untreated metastatic lesions may lead to death within one to two months. Existing therapies—neurosurgery and radiation therapy—do not improve the prognosis for every patient. The discovery of Epidermal Growth Factor Receptor (EGFR)—activating mutations and Anaplastic Lymphoma Kinase (ALK) rearrangements in patients with non-small cell lung adenocarcinoma has allowed for the introduction of small-molecule tyrosine kinase inhibitors to the treatment of advanced-stage patients. The Epidermal Growth Factor Receptor (EGFR) is a transmembrane protein with tyrosine kinase-dependent activity. EGFR is present in membranes of all epithelial cells. In physiological conditions, it plays an important role in the process of cell growth and proliferation. Binding the ligand to the EGFR causes its dimerization and the activation of the intracellular signaling cascade. Signal transduction involves the activation of MAPK, AKT, and JNK, resulting in DNA synthesis and cell proliferation. In cancer cells, binding the ligand to the EGFR also leads to its dimerization and transduction of the signal to the cell interior. It has been demonstrated that activating mutations in the gene for EGFR-exon19 (deletion), L858R point mutation in exon 21, and mutation in exon 20 results in cancer cell proliferation. Continuous stimulation of the receptor inhibits apoptosis, stimulates invasion, intensifies angiogenesis, and facilitates the formation of distant metastases. As a consequence, the cancer progresses. These activating gene mutations for the EGFR are present in 10–20% of lung adenocarcinomas. Approximately 3–7% of patients with lung adenocarcinoma have the echinoderm microtubule-associated protein-like 4 (EML4)/ALK fusion gene. The fusion of the two genes EML4 and ALK results in a fusion gene that activates the intracellular signaling pathway, stimulates the proliferation of tumor cells, and inhibits apoptosis. A new group of drugs—small-molecule tyrosine kinase inhibitors—has been developed; the first generation includes gefitinib and erlotinib and the ALK inhibitor crizotinib. These drugs reversibly block the EGFR by stopping the signal transmission to the cell. The second-generation tyrosine kinase inhibitor (TKI) afatinib or ALK inhibitor alectinib block the receptor irreversibly. Clinical trials with TKI in patients with non-small cell lung adenocarcinoma with central nervous system (CNS) metastases have shown prolonged, progression-free survival, a high percentage of objective responses, and improved quality of life. Resistance to treatment with this group of drugs emerging during TKI therapy is the basis for the detection of resistance mutations. The T790M mutation, present in exon 20 of the EGFR gene, is detected in patients treated with first- and second-generation TKI and is overcome by Osimertinib, a third-generation TKI. The I117N resistance mutation in patients with the ALK mutation treated with alectinib is overcome by ceritinib. In this way, sequential therapy ensures the continuity of treatment. In patients with CNS metastases, attempts are made to simultaneously administer radiation therapy and tyrosine kinase inhibitors. Patients with lung adenocarcinoma with CNS metastases, without activating EGFR mutation and without ALK rearrangement, benefit from immunotherapy. This therapeutic option blocks the PD-1 receptor on the surface of T or B lymphocytes or PD-L1 located on cancer cells with an applicable antibody. Based on clinical trials, pembrolizumab and all antibodies are included in the treatment of non-small cell lung carcinoma with CNS metastases.     

Molecular Mechanism and Prevention Strategy of Chemotherapy- and Radiotherapy-Induced Ovarian Damage

Fertility preservation is an emerging discipline, which is of substantial clinical value in the care of young patients with cancer. Chemotherapy and radiation may induce ovarian damage in prepubertal girls and young women. Although many studies have explored the mechanisms implicated in ovarian toxicity during cancer treatment, its molecular pathophysiology is not fully understood. Chemotherapy may accelerate follicular apoptosis and follicle reservoir utilization and damage the ovarian stroma via multiple molecular reactions. Oxidative stress and the radiosensitivity of oocytes are the main causes of gonadal damage after radiation treatment. Fertility preservation options can be differentiated by patient age, desire for conception, treatment regimen, socioeconomic status, and treatment duration. This review will help highlight the importance of multidisciplinary oncofertility strategies for providing high-quality care to young female cancer patients.     

Photodynamic Therapy (PDT) with Chemotherapy for Advanced Lung Cancer with Airway Stenosis

Intractable advanced lung cancer can be treated palliatively with photodynamic therapy (PDT) combined with chemotherapy to remove central and peripheral (lobar or segmental bronchi) bronchial stenosis and obstruction. We present data for 12 (eight men, four women) consecutive patients with 13 advanced non-small cell lung carcinomas in whom curative operations were contraindicated, who underwent PDT combined with chemotherapy for local control of the intraluminal lesions. The mean age was 73.3 years (range, 58–80 years), and the stages of cancer were IIA–IV. The median stenosis rates before treatment, one week post-treatment, and one month post-treatment were 60% (range, 30%–100%), 15% (range, 15%–99%), and 15% (range 15%–60%), respectively. The mean and median survival times were 9.3 and 5.9 months, respectively. The overall 1-year survival rate was 30.0%. No PDT-related morbidity or mortality occurred. In this single-institution study, all patients experienced improved symptoms and quality of life at one week after treatment; furthermore, an objective response was evidenced by the substantial increase in the openings of the bronchial lumen and prevention of obstructive pneumonia. Therefore, PDT with chemotherapy was useful and safe for the treatment of bronchial obstruction.     

Ozone Therapy in Cancer Treatment: State of the Art

Erhlich Ascitic Tumor and Sarcoma 37 were implanted in mice and afterward the animals were treated with ozone (rectally). A significant decrease in the number of metastasis was obtained. In another study, ozone was applied intraperitoneally, before Lewis' lung carcinoma inoculation. A delayed effect in the tumor development kinetics and in the increase rate of tumor volume in the ozone groups was observed. With regard to the clinical trial, patients with prostatic cancer were treated with cobalt-60 therapy and ozone (rectally), decreasing the presence of side effects (due to radiation treatment) and the prostatic specific antigen figures. However, further investigations are necessary to be performed, in order to be considered the ozone therapy as complementary therapy for cancer.     

Safety of Surgery after Neoadjuvant Targeted Therapies in Non-Small Cell Lung Cancer: A Narrative Review

New drugs, including immune checkpoint inhibitors and targeted therapy, have changed the prognosis in a subset of patients with advanced lung cancer, and are now actively investigated in a number of trials with neoadjuvant and adjuvant regimens. However, no phase III randomized studies were published yet. The current narrative review proves that targeted therapies are safe in neoadjuvant approach. Unsurprisingly, administration of therapy is related to an acceptable toxicity profile. Severe adverse events’ rate that rarely compromises outcomes of patients with advanced lung cancer is not that commonly accepted in early lung cancer as it may lead to missing the chance of curative surgery. Among those complications, the most important factors that may limit the use of targeted therapies are severe respiratory adverse events precluding the resection occurring after treatment with some anaplastic lymphoma kinase and rarely after epidermal growth factor receptor tyrosine kinase inhibitors. At this point, in the presented literature assessing the feasibility of neoadjuvant therapies with anaplastic lymphoma kinase and epidermal growth factor receptor tyrosine kinase inhibitors, we did not find any unexpected intraoperative events that would be of special interest to a thoracic surgeon. Moreover, the postoperative course was associated with typical rate of complications.     

Gene Expression Profile in Primary Tumor Is Associated with Brain-Tropism of Metastasis from Lung Adenocarcinoma

Lung adenocarcinoma has a strong propensity to metastasize to the brain. The brain metastases are difficult to treat and can cause significant morbidity and mortality. Identifying patients with increased risk of developing brain metastasis can assist medical decision-making, facilitating a closer surveillance or justifying a preventive treatment. We analyzed 27 lung adenocarcinoma patients who received a primary lung tumor resection and developed metastases within 5 years after the surgery. Among these patients, 16 developed brain metastases and 11 developed non-brain metastases only. We performed targeted DNA sequencing, RNA sequencing and immunohistochemistry to characterize the difference between the primary tumors. We also compared our findings to the published data of brain-tropic and non-brain-tropic lung adenocarcinoma cell lines. The results demonstrated that the targeted tumor DNA sequencing did not reveal a significant difference between the groups, but the RNA sequencing identified 390 differentially expressed genes. A gene expression signature including CDKN2A could identify 100% of brain-metastasizing tumors with a 91% specificity. However, when compared to the differentially expressed genes between brain-tropic and non-brain-tropic lung cancer cell lines, a different set of genes was shared between the patient data and the cell line data, which include many genes implicated in the cancer-glia/neuron interaction. Our findings indicate that it is possible to identify lung adenocarcinoma patients at the highest risk for brain metastasis by analyzing the primary tumor. Further investigation is required to elucidate the mechanism behind these associations and to identify potential treatment targets.     

Antitumor Effects of Selenium

Functions of selenium are diverse as antioxidant, anti-inflammation, increased immunity, reduced cancer incidence, blocking tumor invasion and metastasis, and further clinical application as treatment with radiation and chemotherapy. These functions of selenium are mostly related to oxidation and reduction mechanisms of selenium metabolites. Hydrogen selenide from selenite, and methylselenol (MSeH) from Se-methylselenocyteine (MSeC) and methylseleninicacid (MSeA) are the most reactive metabolites produced reactive oxygen species (ROS); furthermore, these metabolites may involve in oxidizing sulfhydryl groups, including glutathione. Selenite also reacted with glutathione and produces hydrogen selenide via selenodiglutathione (SeDG), which induces cytotoxicity as cell apoptosis, ROS production, DNA damage, and adenosine-methionine methylation in the cellular nucleus. However, a more pronounced effect was shown in the subsequent treatment of sodium selenite with chemotherapy and radiation therapy. High doses of sodium selenite were effective to increase radiation therapy and chemotherapy, and further to reduce radiation side effects and drug resistance. In our study, advanced cancer patients can tolerate until 5000 μg of sodium selenite in combination with radiation and chemotherapy since the half-life of sodium selenite may be relatively short, and, further, selenium may accumulates more in cancer cells than that of normal cells, which may be toxic to the cancer cells. Further clinical studies of high amount sodium selenite are required to treat advanced cancer patients.