陈曦
副主任医师
3.5
肿瘤内科王钢胜
主任医师
3.4
肿瘤内科段秀泉
主任医师
3.4
肿瘤内科张光林
副主任医师
3.4
肿瘤内科胡文兵
副主任医师
3.4
肿瘤内科黄绪群
副主任医师
3.4
肿瘤内科朱琳燕
副主任医师
3.4
肿瘤内科王旭东
副主任医师
3.4
肿瘤内科费新雄
副主任医师
3.4
肿瘤内科肖大生
副主任医师
3.4
朱小鹏
主治医师
3.3
肿瘤内科赵德庆
主治医师
3.3
肿瘤内科黄治勇
主治医师
3.3
肿瘤内科周蔷
主治医师
3.3
肿瘤内科杜天幸
主治医师
3.3
肿瘤内科龚军
主治医师
3.3
肿瘤内科刘建萍
主治医师
3.3
肿瘤内科华先良
主治医师
3.3
肿瘤内科夏林
主治医师
3.3
肿瘤内科石训仁
主治医师
3.3
柯素颖
主治医师
3.3
肿瘤内科柯珂
主治医师
3.3
肿瘤内科梁毅
主治医师
3.3
肿瘤内科舒畅
主治医师
3.3
肿瘤内科李荣峰
主治医师
3.3
肿瘤内科张炜
主治医师
3.3
肿瘤内科黄俊
主治医师
3.3
肿瘤内科胡美琴
医师
3.3
肿瘤内科叶岚
医师
3.3
肿瘤内科张君
医师
3.3
唐昃
主任医师
3.2
中医肿瘤科姜兰
主治医师
3.2
中医肿瘤科费国新
副主任医师
3.2
中医肿瘤科董克臣
主治医师
3.1
中医肿瘤科徐坚
医师
3.1
中医肿瘤科马丹
主治医师
3.1
中医肿瘤科张梦静
主治医师
3.1
Chaudhuri在美国放射肿瘤学会(ASTRO)第59届年会上介绍了研究结果一项新的研究。该研究,血检对于检出癌症可能预测局部非小细胞肺癌(NSCLC)患者的治疗结果,并为医生个体化治疗复发性疾病提供更多的时间。研究中循环肿瘤DNA(ctDNA)在治疗后不久即具有可检测到水平的患者均在两年内复发,而所有在治疗后不久没有可检测到的ctDNA的患者中只有1例复发,其余仍然无病长期生存。相反,传统的影像,不能预测复发或生存。肺癌的侵袭特性使长期管理尤其具有挑战性。由于NSCLC趋向于进展,即使在治疗后,因此,定期监测复发是必要的。然而,通常用于监测的计算机断层(CT)扫描常常无法检出显微镜下的肿瘤沉积,也无法分辨是疾病复发变化还是治疗引起的正常组织变化。“血检可以检测出治疗后残留的微量肿瘤,或许可以改善复发监测,并可能为医生提供数月的额外时间来调整治疗从而改善患者的结局和生活质量,”研究的第一作者、斯坦福大学放射肿瘤科总住院医师Aadel Chaudhuri医学博士说。“我们的研究结果表明,与CT扫描不同,cDNA分析可以发现治疗完成后不久局部肺癌患者是否通过放疗或手术可能已治愈,或者是否其体内仍然有癌细胞存在。尽管我们预期分子残留病变的ctDNA检测或可以预测临床结局差,但是我们仍惊讶该检测是多么强烈的预测复发和生存。”研究背景在治疗前即刻以及在治疗完成后不久,ctDNA的存在作为Ⅰ-Ⅲ期NSCLC患者的一个标记物估量分子残留病变(MRD)。对于半数接受化放疗(n=13/27)的患者,还在治疗中期(平均3周,范围1.4–3.7周)测定ctDNA水平。通过深度测序(CAPP-Seq)癌症个体化表达谱用来评估是否存在ctDNA。使用实体瘤疗效评价标准(RECIST)评估利用CT成像监测扫描。患者年龄中位数是67岁(范围,47–91岁),大多数(67%)是男性。所有41例患者均接受根治性治疗,包括放化疗(66%)、单纯放疗(27%)和单纯手术(7%)。该研究的中位随访时间为35个月(范围,7-56个月)。结果研究人员在41例患者中的38例(93%)治疗前检出了ctDNA。这38例患者中的34例在治疗结束的4个月内采血(预设的MRD界标)并适于后续分析。治疗前具有ctDNA MRD的34例患者中,超过一半(56%,n=19)在治疗后有可检出的残留病变。所有这些患者随后发生肺癌复发,与之相比,没有可检出ctDNA MRD的15例患者中只有1例复发。与没有可检测到ctDNA MRD的患者相比,在治疗后具有可检测的ctDNA MRD患者有更差的无进展期和生存期(无进展风险比(HR)= 44,P<0.0001;疾病特异性生存率HR=27.7,P<0.0001)。在同一时间的CT成像不能预测生存。治疗前的ctDNA水平也与生存结局无关。在13例治疗中期评估的患者中8例ctDNA占总游离DNA的0.1%或以上。对于这些患者,治疗中期的ctDNA水平预测最终疾病进展(HR=2.7,P=0.006)。治疗中期ctDNA<0.1%的患者治疗后两年无进展生存率为60%,与之相比,ctDNA水平≥0.1%的患者则没有1例患者(HR=4.4,P=0.037)。链接:在未来我们可以对患者提供个性化的处理,靶向手术后复发的肿瘤部位。使用ctDNA,即使病人没有疾病的临床症状,我们也可以识别,也能监测治疗的工作进行得如何。这代表了手术后肺癌复发的新希望,因为在半数以上的患者中,肺癌复发率高达一半。”北京301医院在一项项前瞻性的研究,ctDNA具有较好的一致性和更高的阳性预测值,提示血浆ctDNA可能是监测肿瘤更好的分子标记物。国内首篇对肺癌患者术前术后ctDNA检测的报道,揭示了基于二代测序平台的ctDNA检测技术在早期非小细胞肺癌患者评价中的巨大应用潜力。Circulating tumor DNA detection in lung cancer patients before and after surgery.Sci Rep 2016 Sep 19;6:33519PMID:27641744http://www.ascopost.com/News/58079ASTRO 2017: Biomarker Blood Test Predicts Survival Following Localized Lung Cancer TreatmentBy The ASCO PostPosted: 9/26/2017 1:51:04 PMLast Updated: 9/27/2017 1:18:14 PMFindings were presented by Chaudhuri et alat the59th Annual Meeting of the American Society for Radiation Oncology (ASTRO).Key PointsAmong the 34 patients with ctDNA MRD pretreatment, more than half (56%, n = 19) had detectable residual disease after treatment. All of these patients subsequently developed recurrent lung cancer, compared with only 1 of the 15 patients without detectable ctDNA MRD.Patients with detectable ctDNA MRD after treatment had worse freedom from progression and survival than patients without detectable ctDNA MRD.In 8 of the 13 patients assessed mid-treatment, ctDNA accounted for 0.1% or more of all cell-free DNA. For these patients, mid-treatment ctDNA levels predicted eventual disease. 60% of the patients with less than 0.1% ctDNA mid-treatment were progression-free at 2 years following treatment, compared to none of the patients with 0.1% or higher levels of ctDNA.A new study demonstrates that a blood test to detect cancer may predict treatment outcomes for patients with localized non–small cell lung cancer (NSCLC) and afford physicians additional lead time to personalize treatment for recurrent disease. Patients in the study with detectable levels of circulating tumor DNA (ctDNA) shortly after treatment all had recurrences within 2 years, while all but one of the patients without detectable ctDNA shortly after treatment remained disease-free and survived long-term. Conventional imaging, conversely, was not prognostic for recurrence or survival.The aggressive nature of lung cancer can make long-term management especially challenging. Because NSCLC tends to progress, even following treatment, regular monitoring for recurrence is necessary. The computed tomography (CT) scans typically used for monitoring, however, are often unable to detect microscopic tumor deposits or to distinguish normal tissue changes caused by treatment from changes caused by recurrent disease.“Blood tests that can detect minute traces of cancer that remain after treatment could improve recurrence monitoring and potentially offer physicians months of additional lead time to tailor treatments and improve our patients’ outcomes and quality of life,” saidAadel Chaudhuri, MD, PhD, lead author of the study and Chief Resident in Radiation Oncology atStanford University.“Our findings suggest that ctDNA analysis, unlike CT scans, can identify shortly after treatment completion if a patient with localized lung cancer has likely been cured by radiation or surgery or if he or she still has cancer cells present in their body. While we expected that ctDNA detection of molecular residual disease would predict poor clinical outcomes, we were surprised by how strongly predictive the test was for recurrence and survival.”Study BackgroundPresence of ctDNA was measured as a marker of molecular residual disease (MRD) in patients with stage I–III NSCLC immediately before treatment and shortly after treatment was completed. ctDNA levels also were measured mid-treatment (average = 3 weeks, range = 1.4–3.7 weeks) for half of the patients receiving chemoradiation (n = 13 of 27 patients). Cancer Personalized Profiling by Deep Sequencing (CAPP-Seq) was used to assess whether ctDNA was present. Surveillance scans using CT imaging were evaluated using the Response Evaluation Criteria In Solid Tumors(RECIST).The median patient age was 67 years (range, 47–91 years), and most patients (67%) were male. All 41 patients were treated with curative intent, including with chemoradiation therapy (66%), radiation therapy alone (27%), and surgery alone (7%). Median follow-up for the study was 35 months (range, 7–56 months).FindingsResearchers detected ctDNA pretreatment in 38 of the 41 patients (93%). Thirty-four of these 38 patients had blood drawn within 4 months of treatment completion (the prespecified MRD landmark) and were eligible for subsequent analysis.Among the 34 patients with ctDNA MRD pretreatment, more than half (56%, n = 19) had detectable residual disease after treatment. All of these patients subsequently developed recurrent lung cancer, compared with only one of the 15 patients without detectable ctDNA MRD.Patients with detectable ctDNA MRD after treatment had worse freedom from progression and survival than patients without detectable ctDNA MRD (freedom from progression hazard ratio (HR) = 44.0,P< .0001; disease-specific survival HR = 27.7,P< .0001). CT imaging at the same time was not prognostic for survival. ctDNA levels before treatment also were not associated with survival outcomes.In 8 of the 13 patients assessed mid-treatment, ctDNA accounted for 0.1% or more of all cell-free DNA. For these patients, mid-treatment ctDNA levels predicted eventual disease progression (HR = 2.7,P= .006). Sixty percent of the patients with less than 0.1% ctDNA mid-treatment were progression-free at 2 years following treatment, compared to none of the patients with 0.1% or higher levels of ctDNA (HR = 4.4,P= .037).Commentary“In the future, clinicians may be able to use ctDNA analysis to identify patients who could benefit from additional treatment after first-line therapy,” saidMaximilian Diehn, MD, PhD, senior author of the study and Assistant Professor of Radiation Oncology at Stanford.“In a related study also presented at this year’s ASTRO Annual Meeting, we found that ctDNA analysis detected disease recurrence an average 5.5 months earlier than standard-of-care CT imaging for localized lung cancer and helped with interpretation of equivocal follow-up imaging. This suggests that ctDNA analysis could open a window to treat patients with residual cancer early, while disease burden is minimal.”The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO) and does not necessarily reflect the ideas and opinions of ASCO.
腋网综合征(Axillary Web Syndrome, AWS)是乳腺癌术后的常见并发症。其严重与否取决于伤口的发展或腋窝处结缔组织的情况。腋网综合征会很疼痛,并且影响患侧上臂的活动,以下是关于AWS的详细梳理。AWS形成原因AWS最常见的形成原因就是乳腺癌腋窝清扫术。当乳腺癌手术治疗时,一般会行改良根治术或保乳术。乳腺癌患者也会接受前哨淋巴结活检或腋窝淋巴结清扫术,这是由于腋窝淋巴结为乳腺癌最常见的转移部位之一。前哨淋巴结活检和腋窝淋巴结清扫术的主要区别就是切除多少淋巴结。前哨淋巴结活检只涉及到几个腋下淋巴结,具体视情况而定。但是腋窝淋巴结清扫术涉及到较多的淋巴结。AWS可以在术后的几天或者几周后出现。有些患者在术后几月才会出现相关症状。现在关于AWS的发生机制尚不确定。一个合理的理论是手术会使腋窝的血管和结缔组织受损,导致炎症发生,最终导致周围软组织的硬化。AWS的发生率没有很多统计学的数据支持,不能确定。AWS诊断时一般可见硬化的网状或带状的手术瘢痕,但也有未见伤疤但是有自觉症状的患者。症状AWS也叫做“绳”病,因为在患者皮下可见绳状或条索状的组织。AWS的症状由严重状况的不同而不同,大体来说包括以下几种:瘢痕组织淋巴结切除的区域可见瘢痕组织形成。尽管每个人的厚度不同,但是很容易观察或者摸到。在一些病例中,手术瘢痕可从腋窝延上臂内侧一直延展到肘部、腕部或者手指处。有些患者可能是一个长瘢痕,有些则是很多小的条索状瘢痕。疼痛AWS患者可能会非常疼痛。皮肤也会感觉有牵拉和紧的感觉。如果疼痛感和紧绷感存在,患者的自然反应可能就是减少手臂活动。例如,他们会尽量避免将手臂举过头顶。通过限制上臂活动减少疼痛,可以让她们的情况更糟,由于限制患侧上臂活动可以让她们的组织更紧更硬。体力活动减少像刚才提到的,他们通过减少上臂活动减轻疼痛。当患者手臂不能举过头顶时,会限制她们做很多事情,甚至像穿衣服都很难受,导致体力活动减少。AWS的治疗尽管AWS不是一个可以威胁生命的并发症,但是严重地影响患者生活质量。如果情况轻微,不影响患者的活动范围,可能不需要系统治疗。当推荐患者治疗时,应该以放松瘢痕组织、改善活动范围和减轻不适感为目的。视瘢痕组织范围的情况,可能治疗仅仅可以减轻一部分条索瘢痕导致的紧绷感。例如,如果瘢痕组织从腋窝一直延伸至腕部,那么肘部的区域可能仍然会感觉紧绷。治疗方法如下:正确的的牵拉锻炼在医学指南的规定和医生、物理治疗师的指导下进行拉伸锻炼。具体的拉伸策略根据瘢痕组织的不同而有所差别。下面是指南中的推荐动作之一:◆向侧方抬起手臂,保持肘部挺直;◆从侧方尽力慢慢举起手,直到感觉有拉伸感;◆坚持持续拉伸30秒;◆持续重复该动作,每次力争将手举地更高。坚持拉伸30秒十分关键,如果持续时间较短,那么将起不到锻炼软组织,改善活动范围的作用。按摩多种按摩手段可以对AWS起到缓解作用,例如帮助神经滑动、软组织松解等等。不同的按摩方法可以帮助结缔组织控制、促进疤痕组织分解、改善上臂活动受限状况。按摩需要由专业的按摩治疗师实施现在,对于瘢痕组织分解后到底会发生什么的具体机制尚不明确。一个理论说,瘢痕组织会被身体重吸收。术后患者应该向专业人士寻求按摩治疗,以免组织的进一步受损。激光治疗物理治疗师可以应用低级别激光治疗AWS,通过发射聚焦的激光直接打碎硬化的瘢痕组织。激光治疗可能不对所有人都有效。例如,它会收到瘢痕组织厚度的局限。一些患者可能需要多疗程的激光治疗。激光治疗也有一些副作用,需要临床医生对利弊做出权衡。AWS的家庭护理需要寻求专业人士的帮助指导家庭护理。例如,他们可能告诉患者在家里如何进行拉伸锻炼的方法。其他的家庭护理措施包括:非甾体类止痛药:尽管非甾体类止痛药不能帮助患者解决根本问题,但是可以明显缓解疼痛,对患者的拉伸锻炼也有辅助作用。温热外敷:应用温热外敷的方法可以让局部更加舒适。但是也要遵医嘱适度进行温热外敷,因为外敷过多可以刺激淋巴液的产生,可能让症状加重。
NCCN指南(2015.V1):以下内容摘录编译自2015.V1版的NCCN小细胞肺癌指南,主要为小细胞肺癌(SCLC)的化疗方案选择以及目前所做的临床试验进展。对于所有SCLC患者,化疗是治疗的基本
总访问量 185,096次
在线服务患者 37位
科普文章 25篇