Objective To assess the effectiveness and safety of hyperthermia combined with chemotherapy for advanced colorectal cancer. Methods Databases such as CNKI, VIP, WanFang Data, CBM, EMbase, PubMed and The Cochrane Library (Issue 3, 2012) were electronically searched from the date of their establishment to June, 2012, and the relevant literature and conference proceedings were also manually searched to include randomized controlled trials (RCTs) on comparison of chemotherapy with hyperthermia plus chemotherapy for advanced colorectal cancer. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then the meta-analysis was performed by using RevMan 5.1 software. Results A total of 11 RCTs involving 708 patients with advanced colorectal cancer were included. The results of meta-analysis showed that: a) as for effectiveness, the chemotherapy combined with hyperthermia group was superior to the chemotherapy group in the partial improve rate (OR=1.65, 95%CI 1.39 to 1.97, Plt;0.000 01) and the total effective rate (OR=3.59, 95%CI 2.51 to 5.12, Plt;0.000 01), with significant differences; b) as for safety, the chemotherapy combined with hyperthermia group was lower than the chemotherapy group in the incidence of neurotoxicity (OR=0.50, 95%CI 0.33 to 0.75, P=0.000 8). Conclusion Compared with chemotherapy, chemotherapy combined with hyperthermia can increase partial improve rate and total effective rate and reduce the incidence of neurotoxicity. Due to the limitation of the included studies, large sample size, multicenter, high quality studies are needed to verify the above conclusion. We recommend that chemotherapy combined with hyperthermia therapy could be applied to clinic combining individual conditions of patients.
Objective To explore the effect of different nutrition on the immune function of patients with colorectal cancer. Methods A total of 640 colorectal cancer patients were randomized into the enteral nutrition and peripheral nutrition groups. The peripheral venous blood was sampled before operation and on the postoperative days 1 and 7 to determine the serum levels of IgG, IgA, IgM, the percentage of T lymph cell subgroups CD3, CD4, CD4/CD8 and CRP, PGE, α- antitrypsin etc. The patient’s general condition, side-effects, and complications were observed intimately after surgery. Results Compared with the control group, the IgG, IgA, IgM, CD3, CD4,CD4/CD8 levels of the trial group on postoperative day 7 were higher. But the levels of CRP, PGE, α- antitrypsin were decreased. Hospitalization time and anal exsufflation time were shorter as well. There was no significant difference in either the general conditions or complications between the two groups. Conclusion Application of enteral nutrition after colorectal cancer surgery is safe, ,effective, and can improve the patient’s immune function and prognosis.
Objective To compare and evaluate the effectiveness and safety of irinotecan (IRI) versus oxaplatin (OXA), in combination with 5-FU/LV for patients with advanced colorectal cancer. Methods The literature search, study selection and assessment, data collection and analysis were undertaken by two reviewers according to the Cochrane Handbook for Systematic Reviews of Interventions. Randomised controlled trials (RCTs) or quasi-RCTs comparing IRI versus OXA, in combination with 5-FU/LV in the treatment of advanced colorectal cancer were collected. Results Seven studies involving 2107 patients were included. The OXA/5-FU/LV regimen was superior or at least equal to the IRI/5-FU/LV regimen in prolonging overall survival and time to progression. The OXA/5-FU/LV regimen showed a higher response rate and was associated with lower toxicities. Conclusion Compared with IRI, OXA is more appropriate for the treatment of advanced colorectal cancer when combined with 5-FU/LV.
【摘要】 目的 调强放射治疗（IMRT）能较好的保护危及器官并给予肿瘤足够的致死剂量，基于多叶准直器（MLC）分步照射的IMRT技术对复杂病例需要更多子野。研究对直肠癌术后放射治疗使用不同子野数目的IMRT计划进行比对，选择合理的子野数。 方法 选取2010年4-8月入院的直肠癌术后患者10例，保持射野入射角度及优化目标参数相同，仅改变MLC子野数目，设计不同IMRT对每一患者治疗计划的靶区适形指数（CI）、均匀性指数、最大剂量、最小剂量、平均剂量，危及器官关注体积的受照剂量，机器跳数及治疗时间进行分析。 结果 所有治疗计划中靶区及危及器官的剂量学评估指标无统计学意义（Pgt;0.05），只有亚临床计划靶区（PTV）CI在15个子野的方案中（0.74±0.06）明显差于25个子野方案（0.82±0.03）、40个子野方案（0.81±0.06）及60个子野方案（0.84±0.03），有统计学意义（Plt;0.05）；治疗机器跳数（MU）随子野数目增多明显增大，15、20、40及60个子野方案所需MU分别为（458±56）、（559±62）、（614±74）、（622±82），有统计学意义（Plt;0.05），但40个子野方案与60个子野方案间无统计学意义。治疗时间明显随子野数增加而增大。 结论 直肠癌术后IMRT计划使用25个子野能满足临床剂量要求，同时能有效降低治疗时间，可作为临床应用参考值。【Abstract】 Objective The intensity modulated radiotherapy (IMRT) can deliver tumor enough doses and protect risk organs as much as possible at the same time. The MLC-based step and shoot IMRT(sIMRT) plan needs much more segment member to meet clinical aims. In this study, several sIMRT plans using different segment number for postoperative rectal cancer were compared to find out the most reasonable segment number setting. Methods Ten patients with rectal carcinoma underwent postoperative adjuvant radiotherapy for rectal cancer from April to August 2010 were selected. For each patient, the angle of field, the prescription expected and the physical parameters optimized were kept the same, while only the number of segments was changed in sIMRT plans. The dose volume histogram-based parameters [conformity index (CI) and homogeneous index (HI)] and other parameters concerned were compared and analyzed. Results The indexes of dosimetry associated with the targets and risk organs showed no significant statistical difference among the 4 sIMRT plans with different segment numbers. The index CI of PTV in the sIMRT plan with 15 segments (CI 0.74±0.06) was less than that in the sIMRT plan with 25 segments (CI 0.82±0.03), the sIMRT plan with 40 segments plan (CI 0.81±0.06), and the sIMRT plan with 60 segments (CI 0.84±0.03) (Plt;0.05). There were significant differences in MU among the sIMRT plans with 15 segments (average MU: 458±56) , with 25 segments (average MU: 559±62 ), and with 40 segments (average MU: 614±74)or with the 60 segments (average MU: 622±82 (Plt;0.05). The more segments meant more MU and more irradiation time. Conclusion The sIMRT plan for patients of rectal cancer to receive postoperative adjuvant radiotherapy may require at least 25 segments to balance the accepted dose results and efficient delivering.
目的:评价双吻合器技术在超低位直肠癌保肛术中的实用性。方法:回顾分析我院2006年1月至2009年11月60例超低位直肠癌应用双吻合器技术保肛的临床资料。结果:本组手术中结直肠56例吻合顺利,术后1例吻合口瘘及无出血病例发生,吻合口狭窄2例(333％),无手术死亡病例。结论:应用双吻合器技术可极大提高超低位直肠癌保肛率且并发症少,值得推广。
Objective To investigate the relationship between the expressions of mismatch repair （MMR） genes （include hMLH1 and hMSH2） and clinicopathological features and prognosis of hereditary nonpolyposis colorectal cancer （HNPCC）. Methods Immunohistochemistry method （Elivision-two step） was used to test expressions of hMLH1 and hMSH2 proteins （both hMLH1 and hMSH2 protein-positive delimited as MMR protein-positive） in 48 patients with HNPCCaccording to revised Bethesda guidelines， and analyzed the relationship between the expression of MMR protein and clinicopathological features and prognosis of HNPCC. Results Loss rate of hMLH1 protein （20.83%，10/48） was signi-ficantly higher than that of hMSH2 protein （8.33%，4/48）， Ρ＜0.05， and positive expression rate of MMR protein was 70.83% （34/48）. Expression of MMR protein was related with tumor infiltration depth （Ρ＜0.05）. Survival rate of patients with expression and without expression of MMR protein was 85.29% （29/34） and 85.71% （12/14）， respectively， the survival curves of them didn’t significantly differed from each other （Ρ＞0.05）. Conclusions Loss rate of hMLH1 protein is higher than that of hMSH2 protein. Expre ssions of hMLH1 and hMSH2 protein are related with tumor infiltration depth， but not related with prognosis.
Objective To investigate the sensitivity of 5 kinds of chemotherapeutic drugs on human colorectal cancer in vivo. Methods Xenografts in nude mice were set up by tumor tissues from 9 patients with colorectal cancer and nude mice were divided into 6 groups randomly， receiving saline （control group）， 5-fluorouracil （5-FU group）， doxorubicin（ADM group）， mitomycin （MMC group）， oxaliplatin （LOHP group）， and irinotecan （CPT-11 group）， respectively. The inhibitive rates （IR） of xenografts in 5 groups for each patient were calculated. Results The lowest and highest IR of 5 groups were 23.6% and 54.9% in 5-FU group， 23.7% and 69.5% in LOPH group， 23.6% and 82.6% in CPT-11group， 24.1% and 48.1% in MMC group， 5.8% and 20.7% in ADM group， respectively. The IR exceeded 40.0% in 7 patients of LOHP group， 6 patients of CPT-11 group， 4 patients of 5-FU group， and 1 patient of MMC group， respec-tively. Of 9 patients， the IR exceeded 40.0% to 3 kinds of drugs in 3 patients， to 2 kinds of drugs in 4 patients， the IR didn’t exceed 30.0% to 4 kinds of drug （IR was 82.6% to CPT-11） in 1 patient， and the IR didn’t exceed 31.0% to all 5 kinds of drugs in 1 patient. There were statistical differences on the IR of 5 kinds of drugs （H=24.061 2， P=0.000 1）. IR of ADM group was statistical lower than 5-FU group， MMC group， LOHP group， and CPT-11 group （P＜0.05），but there were no statistical differences between 5-FU group， MMC group， LOHP group， and CPT-11 group （P＞0.05）. Conclusions The xenografts from same patient have different sensitivity to different chemotherapy drugs， and the same chemotherapy drug corresponds to different IR in different patients. The IR of LOHP and CPT-11 are the highest， following by 5-FU and MMC.
目的 对比分析腹腔镜与开腹结直肠癌切除术后早期炎症性肠梗阻（EPISBO）的发生率，总结EPISBO的诊治经验。方法 非随机同期对照分析同一组医师连续实施的812例腹腔镜结直肠癌切除术（LS组）与615例开腹结直肠癌切除术（OS组）患者的资料，比较2组EPISBO发生率的差异。结果 术后EPISBO总发生率为4.56%（65/1 427），均经保守治疗治愈，无死亡病例。 LS组患者术后EPISBO的发生率为3.20%（26/812），低于OS组的6.34%（39/615），P＜0.05。LS组患者术后EPISBO的治愈时间为（7.51±5.72) d，OS组为（8.12±5.74) d，2组差异无统计学意义（P＞0.05）。结论 腹腔镜手术可降低EPISBO的发生率，EPISBO应以保守治疗为主。
目的 探讨腹腔镜与小切口直肠癌根治术对患者机体细胞免疫功能的影响。方法 选取2010年1月至2011年6月期间我院行腹腔镜及小切口直肠癌根治患者102例，其中腹腔镜组53例，小切口组49例。 采用流式细胞仪测定患者术前1d及术后第1及第5天外周血中CD3、CD4+、CD8+、CD19及NK细胞比例的变化，研究不同手术方式对患者细胞免疫功能的影响。结果 术后第1及第5天，腹腔镜组和小切口组患者的CD3、CD4+、CD8+、CD19及NK细胞比例（数）均较术前明显降低（P＜0.05）。同腹腔镜组比较，小切口组术前及术后CD3、CD4+、CD8+、CD19及NK细胞比例（数）的差异均无统计学意义（P＞0.05）。结论 腹腔镜与小切口直肠癌根治对患者机体细胞免疫功能的无明显影响。