Objective To explore clinical characteristics and therapeutic strategy of undifferentiated pleomorphic sarcoma of colon. Methods A retrospective study of 3 patients with undifferentiated peomorphic sarcoma of the colon was conducted. These cases were treated at the Peking Union Medical College Hospital from October 1983 to July 2016. In addition, the clinicopathologic data of 23 patients with undifferentiated pleomorphic sarcoma of colon reported in the literatures were analyzed. Results These 3 cases all received surgery in our hospital, including two patients who received postoperative radiotherapy. These three cases died of the local relapse or metastasis respectively at 5 months, 3 years, and 5 years after surgery. The 23 patients reported in the literatures were treated surgically except for 1 case, of which received chemotherapy after operation in the 2 cases, did not receive adjuvant therapy after operation in the 15 cases, were not reported clearly in the 6 cases. Sixteen cases had the results of follow-up, of which 9 cases had no recurrences or metastases and 7 cases died. Conclusions Undifferentiated pleomorphic sarcoma of colon has no specific clinical manifestation, it’s prognosis is very poor. Surgery is a main treatment for it at present. Thorough resection of tumor at an early stage is essential to patient’s recovery. Treatments such as chemotherapy and radiotherapy could be selected as postoperative adjuvant treatment, however, therapeutic schemes and effectiveness need further to be studied.
The dose data produced by treatment plan system (TPS) in intensity-modulated radiation therapy (IMRT) has many gradient edge points. Considering this feature we proposed a new interpolation algorithm called treatment plan dose interpolation algorithm based on gradient feature in intensity-modulated radiation therapy (TDAGI), which improves the Canny algorithm to detect the gradient edge points and non-edge points by using the gradient information in the dose data plane. For each gradient edge point, the corresponding gradient profile was traced and the profile's sharpness was calculated, and for each non-edge point, the dispersion was calculated. With the sharpness or dispersion, the kernel coefficients of bi-cubic interpolation can be obtained and can be used as the central point to complete the bi-cubic interpolation calculation. Compared with bi-cubic interpolation and bilinear interpolation, the TDAGI algorithm is more accurate. Furthermore, the TDAGI algorithm has the advantage of gradient keeping. Therefore, TDAGI can be used as an alternative method in the dose interpolation of TPS in IMRT.
目的:比较宫颈癌术后的三维适形放疗(3D-CRT)和调强放射治疗(IMRT)放射治疗计划的剂量学差异。方法:使用Elekta公司的PrecisePLAN Release2.11计划系统设计常规四箱形野(3D-CRT)和调强放疗(IMRT)计划。通过剂量体积直方图比较二者的放射物理参数,评价其应用价值.结果:IMRT计划中靶区平均剂量略高于3D-CRT计划中的相应值,其靶区适形度明显占优。同时,IMRT计划中的膀胱、直肠、小肠、股骨头等危险器官受到的平均剂量低于3D-CRT计划中的相应值,除右股骨头受到的平均剂量差异没有统计学意义,其它数据的差异都具有统计学意义。结论:对于宫颈癌术后患者的放射治疗,IMRT技术在保证肿瘤放射剂量的同时最大限度地减少了危险器官的照射剂量,减少了并发症的发生,应该更广泛地应用于临床。
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.
Objective To comprehend the concept， pathology， molecular mechanisms， diagnosis， and treatmentof aggressive fibromatosis （AF）， and to find a novel way to cure aggressive fibromatosis. Method The literatures about the definition， molecular mechanisms， and clinical research of AF were reviewed and analized. Results AF is rare and benign fibromatous lesion that is the result of abnormal proliferation of myofibroblasts. The pathologic features of AF isa benign disease， but it has “malignant” biological behavior. The tumor often involved the surrounding organs and bloodvessels， and caused death of patients. For patients with clinical symptoms or complications， complete excision of thetumor is the treatment of choice. Even if the operation to ensure the negative margin also has a higher recurrence rate， soits treatment requires multidisciplinary treatment. Conclusions The mechanism of AF is very complex， and it’s mecha-nism is still unclear. Clinical management of patients with AF is difficult and controversial， at present， the most effective treatment for AF is operation resection. The effects of adjuvant radiotherapy， chemotherapy， and other treatment after operation for AF still need further study.
ObjectiveTo summarize the value of imaging in the evaluation of non-surgical therapy for pancreatic cancer.MethodThe relevant literatures about imaging evaluation of non-surgical therapy for pancreatic cancer were collected to make an review.ResultsAt present, most of the imaging evaluation of non-surgical therapy for pancreatic cancer were based on the assessment of morphological characteristics of tumors, such as contrast-enhanced CT and MRI. However, only morphological changes of tumors could not accurately evaluate the response of pancreatic cancer after non-surgical treatment. A few studies had explored the value of functional imaging and artificial intelligence.ConclusionsNon-surgical therapy provides new treatment opportunities for unresectable pancreatic cancer, especially the proposed of neoadjuvant therapy, which provides the possibility of operation for patients with advanced pancreatic cancer. More imaging indicators with stronger objectivity, higher accuracy, and wider universality need to be improved and developed in the future.
ObjectiveTo systematically review the efficacy and safety of radio-chemotherapy combined with thermotherapy for cervical cancer. MethodsLiterature about the efficacy and safety of radio-chemotherapy combined with thermotherapy for patients with cervical cancer at mid-term/advanced stage was retrieved from digital databases of The Cochrane Library (Issue 7, 2013), PubMed, EMbase, CBM, VIP, CNKI, and WanFang Data, and from their established dates to July, 2013. Data extraction and quality assessment of included studies were conducted by two reviewers independently. RevMan 5.2 software was then used to perform meta-analysis. ResultsA total of 9 randomized controlled trials involving 693 patients were included. The results of meta-analysis showed that, compared with the radio-chemotherapy alone group, the radio-chemotherapy combined with thermotherapy group had significant increased 1-year survival rates (OR=3.05, 95%CI 1.70 to 6.68, P=0.005), 2-year survival rates (OR=2.29, 95%CI 1.19 to 4.38, P=0.01), and overall effective rates (OR=3.66, 95%CI 2.31 to 5.81, P < 0.000 01). The incidence of adverse reactions was no statistically significant between the two groups. ConclusionRadio-chemotherapy combined with thermotherapy improves long-term survival rates and short-term curative effects for patients with cervical cancer at mid-term/advanced stage. However, due to the limited quantity and quality of the included studies, more high quality studies with large sample size and long-term follow-up are still needed to verify the above conclusion.
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.
Objective To investigate the trend of breast cancer treatment and prognosis in 30 years. Methods Total 1 092 patients with breast cancer treated in the Peking Union Medical College Hospital between 1975 and 2006 were reviewed in six time phases for therapy, metastasis, and survival rate. Six time phases were 1975-1980 years, 1985-1986 years, 1990-1991 years, 1995-1996 years, 2000-2001 years and 2005-2006 years. Results Radical operation was the major treatment (68.9%， 91/132) of breast cancer in 1975-1980 and then became less popular until it was totally abandoned after 2001. The number of modified radical operation begun to rise from 1980 and reached its peak in 1995-1996 (94.9%， 146/154). The number of lumpectomy had been increasing since 2000, and that of chemotherapy had been rising since 1985-1986. But there was no apparent change of the percentage of radiotherapy treatment. In 1975-1980, only 0.8% （1/126） patients received endocrine therapy, but in 1990-1991, the ratio was 66.0% （33/50）. The metastasis and recurrence ratio was declining gradually in the 6 time phases (P＜0.05). The 5-year and 10-year disease free survival rates in the groups of 1990-1991, 1995-1996, 2000-2001, and 2005-2006 were apparently higher than those in two earlier groups of 1975-1980 and 1985-1986 (P＜0.05). Conclusion The conclusions of laboratory experiments and clinical trials on breast cancer are critical for improving prognosis.
目的 探讨不能手术治疗的恶性梗阻性黄疸给予介入治疗及术后行放射治疗的效果。方法 对笔者所在单位2006年6月至2011年6月期间收治的68例不能手术治疗的恶性梗阻性黄疸患者在X线导向下行经皮经肝胆道内外引流及金属内支架引流术，对胆道金属内支架置入术后行放射治疗的临床资料进行回顾性分析与总结。结果 行内外引流管引流28例次，金属内支架置入63例次。55例胆管癌患者胆道金属内支架置入后再行放射治疗，13例患者单纯行胆道内外引流管引流，全部患者的黄疸均得到改善。行胆管肿瘤组织活检51例和胆汁脱落细胞学检查68例，总阳性率为58.8% （40/68），术后0.5、1及3年存活率分别为95.6% （65/68），70.6% （48/68）和14.7% （10/68）。结论 恶性梗阻性黄疸在失去手术治疗机会后采用介入治疗解除胆管梗阻，减轻肝脏损害，胆道金属内支架置入术后再行放射治疗，有助于提高患者生存质量，延长患者生存时间。