Objective:CA15-3 and CEA,the most common serum markers of follow-up study,seem not so sensitive to monitor the tumor progression of breast cancer in our clinical practice nowadays.Whereas it is reported that the overexpression of Her-2/neu in breast tissue was well related to the poor prognosis of patients.This study was to find out the more accurate serum markers,single or combined,to follow-up in breast cancer patients.Methods:ELISA essay was applied to test the serum expressions of HER-2 in 44 female breast cancer patients before and after chemotherapy and/or radiation therapy.Meanwhile the diagnostic value of the HER-2 expression was in comparison with that of the vascular endothelial growth factor(VEGF),basic fibroblast growth factor/(b-FGF),epidermal growth factor(EGF),CEA and CA15-3 detected concurrently.Follow-up studies were performed every six months until disease progression.Results:The serum HER-2 in breast cancer had a significant decrease after the treatment(14.23ng/ml vs.6.39ng/ml).They were related to the tumor progression,and their levels significantly elevated in the progression group(21.73ng/ml vs.5.36ng/ml).We also found that the specificity of serum HER-2 alone in determination of disease progression was 80.95%,combined determination of serum HER-2 and b-FGF showed the highest sensitivity of 90.91%,while serum HER-2 and CA15-3 showed the highest accuracy rate of 78.05%.The logistic model demonstrated that serum HER-2 level and CA15-3 level after treatment were the main prognostic factors of progression-free survival.Conclusion:Serum HER-2 level increased with tumor progression.As it is easy to detect,it can be used alone or combined with CA15-3 in follow-up studies for breast cancer patients.

IntroductionWe report outcomes for a phase II study of the combination of weekly docetaxel and cisplatin in elderly patients with advanced non-small cell lung cancer.MethodsPatients with chemotherapy-naive, stage IIIB/IV, an Eastern Cooperative Oncology Group performance status of 0 or 1, ages 70 years or older, were eligible. Chemotherapy consisted of cisplatin (25 mg/m2) on days 1, 8, and 15 and docetaxel (20 mg/m2) on days 1, 8, and 15 every 4 weeks.ResultsForty-six (95.8%) of the 48 patients were assessable for response, 1 case of complete response and 18 cases of partial response were confirmed, giving an overall response rate of 39.6% (95% confidence interval [CI], 25.7–53.5%). The median time to progression and overall survival for all patients was 5.0 months (95% CI, 4.1–5.7 months) and 10.9 months (95% CI, 9.6–12.2 months), respectively. The most severe hematologic adverse event was anemia, which occurred with grade 3 intensity in 6 (13.0%) patients and grade 4 in 2 (4.3%) patients. Neutropenia occurred with grade 3 intensity in 4 (8.7%) patients. Grade 3 asthenia, diarrhea, neuropathy, stomatitis, and nausea/vomiting were observed in 2 (4.3%), 5 (10.9%), 5 (10.9%), 5 (10.9%), and 3 (6.5%) patients, respectively. Yet, no grade 4 nonhematologic toxicity was observed.ConclusionsThe combination of weekly docetaxel and cisplatin is a well-tolerated treatment modality with encouraging activity and survival outcome in previously untreated elderly patients with advanced non-small cell lung cancer.

OBJECTIVE:To investigate the effect of preoperative radiotherapy or chemoradiotherapy on the sphincter preservation and local tumor control as well as survival for the patient with locally advanced middle-low rectal cancer.METHODS:121 locally advanced middle-low rectal cancer patients were treated with preoperative radiotherapy or chemoradiotherapy followed by surgery after rest of 4 to 6 weeks. 103 of these patients who underwent radical surgery were finally included in this study. The irradiation regimen was: 40 Gy/4 - 5 weeks, whereas 57 of these 103 patients received concurrent chemotherapy of 5-Fu or Xeloda. Sphincter-preserving surgery was performed in 59 patients and abdominoperineal resection in 44 patients. The survival was estimated by Kaplan-Meier model, and the differences between groups were compared using Log rank test. Multivariate analysis was performed by Cox's model.RESULTS:Ten patients (9.7%) achieved a complete pathological response (pCR) to preoperative radiotherapy or chemoradiotherapy. The sphincter preservation rate was 57.3%. The 3-year overall survival (OS) and disease free survival (DFS) was 66.3% and 59.5%, respectively. Univariate analysis showed that pCR and postoperative pTNM stage were prognostic factors affecting survival, whereas, only pTNM stage was an independent prognostic factor (P = 0.003) by multivariate analysis.CONCLUSION:Neoadjuvant preoperative radiotherapy and chemoradiotherapy is effective in local tumor control and improving survival for locally advanced middle-low rectal cancer, which can raise the rate of sphincter-preserving surgery, and achieve comparable result to abdominoperineal resection.

病例:患者,男,32岁,因咳嗽伴咯痰、晨起血痰1月余,至我院就诊.予抗炎、止血等对症治疗后略有好转.血常规、肝肾功能及B超等检查均未见异常;胸片示右中纵隔影增大;CT及MRI示右后纵隔占位,考虑神经源性肿瘤可能,巨淋巴结增生待排(见图1、2).纤维支气管镜活检未见癌细胞,右后纵隔肿块穿刺活检行HE染色,发现组织中淋巴细胞、浆细胞及嗜酸性细胞浸润,散在体积较大的上皮样异型细胞.

目的:比较早期隔上霍奇金淋巴瘤(HD)斗篷野与累及野放疗联合化疗的疗效.方法:对35例早期HD患者,先予化疗4个疗程,然后随机分为常规斗篷野放疗(20例)或累及野放疗(15例),剂量为大野30Gy,局部肿块区加至40Gy,放疗后再化疗2个疗程.结果:中位随访58个月.3年总生存率为94.3%.无复发生存率为80.0%.两组3年总生存率及无复发生存率无明显差异.结论:早期隔上HD在化疗基础上,累及野与斗篷野放疗疗效相似,并发症较低.

Objective To investigate the pathological changes after radiation in rectal cancers. Methods 25 patients with advanced carcinoma of the rectum underwent preoperative radiation (40 Gy) followed by complete surgical resection of the tumor with total rectal excision. The time interval between completion of radiation and surgical resection was 28 days. Pathology slides with HE stain and TUNEL or PCNA stains partly were reviewed. The expression and distribution of necrosis, mitosis and apoptosis were observed in the radiation group (n =25) and non -radiation group (n = 25) of rectal cancers. Results Of the 25 rectal cancers in radiation group, 8(32% ) , 5(20% ) and 2(8% ) cases showed necrosis (++) , (+ ++) and (+ + + + ) , respectively, higher than that in the non - radiation group ( P 0. 001). However, There were no statistical differences in necrosis(+) , mitosis and apoptosis between the radiation group and the non - radiation group ( P 0. 05 ). Conclusion Necrosis of rectal cancer cells is the most direct pathological changes after radiotherapy. Evaluation of pathological changes rectal cancers after radiation may be useful in treatment of advanced cancer.

目的:分析直肠癌根治术后局部复发的类型、综合治疗的疗效及预后.方法:对直肠癌术后局部复发、以往未接受过放疗的66例病人进行疗效分析.原手术方式为经腹直肠切除术45例(Dixon术40例,Parks术5例),腹会阴直肠切除术21例.经腹直肠切除术后复发以吻合口为主(37/45,82.2%),腹会阴直肠切除术后复发则以盆腔或会阴为主(19/21,905%).复发后盆腔放疗中位剂量为40(20～64)Gy,临床症状缓解中位剂量26(10～52)Gy.其中26例在放疗过程中或之后接受过中位7个(2～12)疗程以5-FU为主的化疗.有22例放疗后获补救手术机会.结果:全组中位生存期24个月.Kaplan-Merier法计算生存率,放疗后1、3年总生存率分别为72.2%、17.9%.单因素分析并Log-rank检验生存率差异,显示生存率与原发病变的期别、术后复发时间、复发部位及是否加用化疗无关,而仅与是否再次行补救手术有关.放疗后加用补救手术者3年生存期明显较长,为36.0%比8.8%(P=0.016).结论:直肠癌根治术后局部复发者,放疗具有良好的姑息减症的作用;对部分经腹直肠切除术后的复发病例,放射治疗加补救手术能明显延长生存期.

Objective:　To evaluate and compare the effects of pre- and postoperative radiotherapy on rectal cancer. Methods:　One hundred and seventy-six cases of histologically proved rectal cancer admitted from February 1988 to February 1995, were divided into 3 groups. Group one: 38 patients(T2:68.4%) were treated with a single fraction preoperative radiotherapy, with a tumor dose of 5 Gy; operation was performed within 48 hours. Group two: 43 patients(T3～4:60.5%) were treated by the conventional preoperative radiotherapy regimen with a median tumor dose of 40Gy in 20 fractions, with a daily dose of 1.8～2Gy, followed by surgery within 4 weeks. Group three: 95 patients(T3～4:62.1%,T2～4N＋:81.1%) underwent postoperative radiotherapy with a median tumor dose of 54Gy in 30 fractions, with a daily dose of 1.8Gy, 3～4 weeks after surgery. Results:　The 3-yr and 5-yr survival rates were: 78.9% and 50.0% in group one, 67.4% and 51.1% in group two, 58.9% and 43.1% in group three. Local recurrence rates were:13.1% and 23.6% , 11.6% and 27.9%, 23.1% and 28.4% in the 3 groups, respectively. Only the 3-yr local recurrence rate of the two preoperative radiotherapy groups were significantly lower than those of the postoperative radiotherapy group (P<0.05). Conclusions:　Compared with the postoperative radiotherapy regimen, preoperative radiotherapy with a proper dosage had better local control and fewer complications.

目的:分析脊柱转移瘤的治疗和预后因素.方法:91例脊柱转移瘤患者于1992年1月至1996年12月在我院治疗,其中放疗66例,同位素治疗25例.原发以乳腺癌和肺癌为主,各占27.4%和24.1%.治疗前不同程度神经功能障碍的75例,占82.4%,1年以内出现转移的共有64例,占70.4%.用中位生存期分析生存率差异,用Log-rank行差异性检验.结果:全组中位生存期10个月,乳腺癌最长,为14.5个月,其次泌尿系肿瘤为14个月,最短为原发不明者为2个月.治疗前有不同程度神经功能障碍者中位生存期明显短于仅有局部疼痛者,分别为10个月、3.5个月和34个月.1年以内出现继发转移者,中位生存期明显较短,为5.5个月.结论:放疗、同位素治疗对脊柱转移瘤具有较好的姑息止痛效果,总有效率为78.0%.影响生存的主要因素有原发部位、治疗前神经功能状况、继发转移出现的早晚和有无脏器转移.