Objective: To summarize and analyze the clinical data and treatment of the cancer pain clinical pathway. Methods: There were 357 cases in cancer pain clinical pathway, from March 22, 2013 to March 26, 2015, were involved. Their cancer pain numerical rating scale (NRS), breakthrough pain (BTP) and treatment are summarized and analyzed. Results: On admission there are 135 cases (37.8%) with mild pain, 155 cases (43.4%) with moderate pain, 67 cases (18.8%) with severe pain. 172 cases (48.2%) have BTP, of whom 21 have BTP 3 times/day or more. At discharge 68 patients are dead. In the other 289 patients there are 273 cases (76.5%) with mild pain, 15 cases (4.2%) with moderate pain, 1 case (0.3%) with severe pain. 39 cases (10.9%) have BTP, of whom 4 have BTP 3 times/day or more. Conclusions: The intensity and BTP of the patients'cancer pain are significantly decreased under the management of cancer pain clinical pathway.

Objective: To explore the diagnostic value of endobronchial ultrasonography with a guide sheath (EBUS-GS) for peripheral pulmonary ground glass opacity (GGO). Methods: The clinical data of 27 consecutive patients with 27 GGOs diagnosed by EBUS-GS between November 2014 to December 2015 in our Cancer Hospital were retrospectively analyzed. The average age of these 27 patients, including 9 males and 18 females, was 59±11 years. The median lesion size of the 27 GGOs was 2.9±1.2 cm, including 24 mixed GGOs and 3 pure GGOs. EBUS images of all 27 GGOs were evaluated, cytological, histological and combination diagnosis analyzed, and complications observed. Results: Under thin bronchoscope, 2 out of 27 cases showed bronchial stenosis, 1 showed bronchial stenosis with mucosal swelling, and the other 24 did not show abnormalities. Twenty-five out of 27 GGOs were found by EBUS, including 22 cases of mGGO and 3 of pGGO. In these ultrasonic images of 22 mGGOs, 18 showed mixed blizzard sign, 3 showed diffusely heterogeneous acoustic shadow and 1showed blizzard sign. Ultrasonic images of 3 pGGOs all appeared as blizzard sign. Twenty-six cytological specimens were obtained, and 16 were diagnosed clearly. All 27 histological specimens were collected, and 18 were diagnosed clearly. Nineteen of 27 cases were diagnosed by combination of cytological and histological specimens. One complication of EBUS-GS with mild bleeding was observed, and hemorrhage was terminated by conservative treatment. Conclusions: EBUS-GS is valuable for GGO diagnosis with less complications and higher safety. GGO ultrasonic image manifested as mixed blizzard sign, blizzard sign or diffusely heterogeneous acoustic shadow.

目的 探讨食管癌骨转移患者的临床特征及预后.方法 选取1981年3月至2012年12月间收治的1 383例接受骨扫描检查的食管癌患者,分析其中131例骨扫描确诊骨转移患者的资料.结果 食管癌骨转移的发生率为9.5％,自确诊食管癌至骨转移的中位时间为8.4个月,骨转移后中位生存时间为6.6个月,1年生存率为26.2％.脊柱转移率明显高于其他骨转移部位,其中尤以胸椎转移率最高(23.4％),其次为骨盆49例(20.8％)、肋骨42例(18.2％)、腰椎36例(15.6％).多发病灶82例(62.6％),单发病灶49例(37.4％).食管癌不同原发部位间在骨转移部位的分布上无统计学差异,初诊时有淋巴结转移者骨盆转移率高于无淋巴结转移转移者.单因素分析结果显示,骨痛治疗后缓解、骨转移的治疗、骨盆转移与食管癌骨转移患者的预后有关(均P＜0.05).多因素分析结果显示,骨转移的治疗、骨盆转移是食管癌骨转移患者预后的独立因素.结论 食管癌骨转移预后较差,骨盆转移影响预后,放化疗治疗可能给患者带来生存获益.

OBJECTIVE:To investigate the clinical characteristics and prognostic factors of leptomeningeal metastases (LM) from solid tumors and to develop better treatment strategies.METHODS:The clinical characteristics and follow-up results of 77 cases of leptomeningeal metastases (LM) from solid tumors diagnosed and treated in our hospital from 2002 to 2011 were retrospectively analyzed. Clinical characteristics, treatment methods and overall survival were analyzed using Kaplan-Meier method and Cox regression model.RESULTS:The median survival time for all the patients was 88 days. KPS score, control of the primary tumor and systemic treatment were correlated with survival time for the patients (P < 0.05 for all). The median survival time of systemic treatment was 150 d and those without systemic treatment (chemotherapy and/or targeted therapy) after LM was 60 d (P = 0.001). Systemic therapy combined with local treatment (radiotherapy to the meninges or intrathecal chemotherapy) further improved the survival time of patients. Multivariate analysis showed that KPS and short-term therapeutic response for the LM were independent prognostic factors (P < 0.05 for both).CONCLUSIONS:KPS and short-term therapeutic response are independent prognostic factores for leptomeningeal metastases from solid tumors. Systemic chemotherapy or targeted therapy can prolong the survival time. Systemic treatment (chemotherapy and/or targeted therapy) combined with radiation therapy or intrathecal injection may further improve the clinical outcomes.

<正>原发性肝癌是我国常见的恶性肿瘤之一,其发病隐匿,早期症状不明显,临床有典型症状时,多属晚期,且病死率极高,近年来其发病有增高趋势。现对我院2007年1月～2010年10月间住院死亡的53例晚期原发性肝癌临床资料进行回顾性分析。1.材料与方法1.1病例来源中国医学科学院肿瘤医院2007年1月～2010年10月间共收治原发性肝癌患者2223例,死亡62例。排除早期肝癌、入院不足24小时、临床资料不完整者,共选取死亡的53例晚期肝癌进行研究。其中经病理学确诊为肝细胞癌9例,肝内胆管癌3例;经影像学临床诊断为原发性肝癌者41

癌性溃疡是恶性肿瘤严重的皮肤表现之一,临床表现为局部皮肤经久不愈的大面积溃烂、渗血、腐臭、流脓.

BACKGROUND & OBJECTIVEPatients with advanced tumors usually suffer from cardiac dysfunction. Monitoring cardiac function is important for these patients. Serum creatine kinase of MB type (CK-MB) is a biochemical marker of cardiac damage. This study was to estimate relationship of serum level of CK-MB to cardiac function of patients with advanced tumors, and its prognostic value.METHODSSerum CK-MB in 68 patients with advanced tumors was detected by immunoinhibition assay. Observation group was composed of 34 patients with elevated serum CK-MB. Control group was composed of 34 patients with normal serum CK-MB level.RESULTSIncidence of cardiac insufficiency of grade III-IV was significantly higher in observation group than in control group (21 vs. 6, P < 0.05). Mortality of observation group was significantly higher than that of control group (25 vs. 8, P < 0.01). Elevation of serum CK-MB was frequently found in patients with primary liver cancer or liver metastasis (P < 0.05).CONCLUSIONSPatients with elevated serum CK-MB often suffer from cardiac insufficiency, severe illness status, and have high mortality. Serum level of CK-MB may be a predictor of poor prognosis of patients with advanced tumors.

Objective To discuss the clinical features of non-small cell lung cancer with skeletal metastases.Methods The clinical materials of 194 non-small cell lung cancer patients were retrospectively analyzed.Results 132 patients(68.0%) had multiple skeletal metastases and 61 patients(31.4%) had single skeletal metastasis.Of the 194 patients,117(60.3%) was adenocarcinoma,46(23.7%) was squamous carcinoma,8(4.1%) was adenosquamous carcinoma,22(11.3%) was carcinoma,1(0.5%) was large cell carcinoma.Skeletal metastases was the first manifestation in 17(8.8%) patients,discovered by medical examination in 91((46.9%)) patients and discovered after treatment in 86(44.3%) patients.Ribs were the most frequently involved metastatic site.Thoracic vertebrae,pelvis and lumber vertebrae were the next.In patients who had been performed X-ray,CT,MRI examination,84(84/87) showed osteolytic damage,2(2/87) showed osteoblastic damage,1(1/87) showed mixed damage.72 patients(72/183) had elevated serum AKP level.The 1-year survival rate was 30.5% and the median survival was 7 months.The survival was observed at a significant different rate between the chemotherapy group and the none chemotherapy group(P0.01).Conclusion Skeletal metastases in none small cell lung cancer is characterized by multiple osteolytic damage.Adenocarcinoma has the highest rate of skeletal metastases.Elevated serum AKP level has only reference value for the diagnosis of skeletal metastases of none small cell lung cancer.Chemotherapy may prolong survival of patients with advanced none small cell lung cancer.

Objective To investigate the partial volume effect (PVE) on the dual-head coincidence (DHC) FDG images. Methods Eighteen times of emission scanning were performed with different levels of radioactive concentration, 4.33～58.38 kBq/ml (total radioactivity 15～204 MBq) on a cylindrical phantom using DHC system (GE Millennium VG Hawkeye). The images were reconstructed using OSEM algorithm with post filter Hanning (cutoff frequency, 0.6). Results The results showed the hot lesion recovery coefficient decreased with the escalation of the lesion size, the region of interest drawn and the true radioactive concentration; and their full width at half maximum increased with the escalation of the radioactive concentration. Conclusion PVE is related to the radioactive concentration as well as the size of the lesion; it increases along with the escalation of the radioactive concentration and the decrement in the lesion size.

Objective To determine the pixel radioactive concentration using the pixel counts on dual head coincidence detection (DHC) FDG images. Methods To convert the count rate per pixel into radioactivity concentration, the calibration factor (CF) was determined by phantom studies. The DHC equipment was produced by GE Hawkeye. The phantom was Toshiba AZ 618 SPECT phantom. Emission scanning was performed for 18 times with the radioactivity escalating stepwise at a range of 15.15～204.33 MBq. Results ①The CF depended on the detected single count rate, and the relationship was expressed with a biquadratic polynomial. ②The radioactive concentration of lesion pixel depended on the pixel counts, the acquisition time and CF, and the relationship was expressed with an empirical formula. Conclusion A method for calculating the pixel radioactive concentration is developed and it would lay the foundation for quantitative analysis of DHC images.