骨肿瘤规范化治疗与研究展望

近30年来，骨与软组织肿瘤的治疗在整个骨科领域中所占的比重虽然不大，但其进步是非常显著的。随着化疗的引入，手术技术的提高，综合治疗和规范化治疗的倡导，骨与软组织肿瘤的诊治水平和策略有了长足的发展。对于常见的骨与软组织原发肿瘤，治疗的总体方案归结为以手术为主导，放化疗为辅助的综合治疗，患者的生存率较前大大提高，复发率明显降低，功能评定显著改善。在当前的总体治疗策略上，我们仍然一贯地推崇骨肿瘤的规范化治疗，并不遗余力地在全国进行推广。倡导规范化、推动规范化、推崇创新研究，是目前骨肿瘤学科的鲜明特点。

Surgery following neoadjuvant chemoradiotherapy (NCRT) is a common multidisciplinary treatment for resectable esophageal cancer (EC). Atfer analyzing 12 randomized controlled trials (RCTs), we discuss the key issues of surgery in the management of resectable EC. Along with chemoradiotherapy, NCRT is recommended for patients with squamous cell carcinoma (SCC) and adenocarcinoma (AC), and most chemotherapy regimens are based on cisplatin, lfuorouracil (FU), or both (CF). However, taxane-based schedules or additional studies, together with newer chemotherapies, are warranted. In nine clinical trials, post-operative complications were similar without significant differences between two treatment groups. In-hospital mortality was signiifcantly different in only 1 out of 10 trials. Half of the randomized trials that compare NCRT with surgery in EC demonstrate an increase in overall survival or disease-free survival. NCRT offers a great opportunity for margin negative resection, decreased disease stage, and improved loco-regional control. However, NCRT does not affect the quality of life when combined with esophagectomy. Future trials should focus on the identiifcation of optimum regimens and selection of patients who are most likely to beneift from speciifc treatment options.

Objective:To investigate the recurrence sites, risk factors, and prognosis of patients with persistent or recurrent squamous cell carcinoma (SCC) of the cervix within one year atfer undergoing concurrent chemoradiotherapy (CCRT).
Methods:Clinical data of 30 patients with persistent or recurrent SCC of the cervix within one year atfer CCRT between July 2006 and July 2011 were analyzed retrospectively. hTese data were compared with those of 35 SCC cases with no signs of recurrence atfer complete remission. hTese 35 patients were treated during the same period (between 2006 and 2011) and selected randomly.
Results:Among these 30 patients, 25 exhibited distant metastases of which 14 were observed within 6 months atfer CCRT. Univariate analysis showed higher incidence of pelvic or para-aortic lymphadenectasis and SCC-ag>10 ng/mL in the group with persistent or recurrent disease before treatment (P<0.01). Multivariate analysis by logistic regression revealed that the pre-therapeutic pelvic or para-aortic lymph node enlargement and SCC-ag>10 ng/mL were the independent risk factors. Palliative chemotherapy was the main treatment option for patients with persistent or recurrent disease. hTe 2-year survival rate was 21.7%, and the median survival time was 17 months.
Conclusion:Patients with persistent or recurrent SCC of the cervix atfer CCRT exhibited a high rate of distant metastasis with poor prognosis. The pre-therapeutic pelvic or para-aortic lymph node enlargement and SCC-ag>10 ng/mL were identiifed as the independent risk factors for persistent or recurrent SCC within 1 year atfer CCRT.

EGFR expression as a predictive marker in esophageal squamous cell cancer:Review article

Objective:This randomized control ed clinical study was to assess and compare the ef icacy and safety of two chemoradiotherapy regimens [cisplatin+5-fluorouracil+3 dimensional conformal radiation therapy (3DCRT) and cisplatin+weekly docetaxel+3DCRT] in patients with local y advanced esophageal squamous cel carcinoma. Methods:A total of seventy-four patients with clinical stages IIB to IIIB esophageal squamous cel carcinoma were enrol ed. Chemotherapy for PF group comprised 5-fluorouracil at days 1-5 (250 mg/m2/d) and cisplatin (20 mg/m2) at days 1-3 of every 28-day cycle;ful treatment course included 2 cycles. Chemotherapy for DP group comprised docetaxel (20 mg/m2) and cisplatin (20 mg/m2) at days 1, 8, 15, 22, 29, and 36. Both groups treated with concurrent 60 Gy 3DCRT at 200 cGy/d. Results:Seventy-four patients were enrol ed and 71 completed the planned treatment, with a fol ow-up rate of 95.94%. Short-term curative ef ect was not statistical y significant between the two groups (P=0.471). The 2-year survival rates were 65.7%and 61.1%, respectively (P=0.806), 5 years survival rates were 34.29%and 27.78%, respectively (P=0.221), and there was no significant dif erence by Fisher test (P=0.734). As common side ef ects, incidence rates of radioactive esophagitis and hematological toxicity were lower in DP group. Conclusion:For local y advanced esophageal cancer patients, current chemoradiotherapy with chemo-therapy regimen of weekly docetaxel plus cisplatin has equal curative ef ect with 5-fluorouracil plus cisplatin, but wel-tolerated by reducing side ef ects such as radioactive esophagitis and bone marrow suppression.