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晚期恶性黑色素瘤的新药治疗进展

恶性黑色素瘤是起源于神经嵴黑色素细胞的高度恶性肿瘤。近10年来，恶性黑色素瘤发病率日益增加。世界卫生组织报道全球每年新发皮肤恶性黑色素瘤大约13.2万例，而我国每年新发病例已超过1万例。恶性黑色素瘤易于远处转移和扩散，而晚期患者的治疗手段有限，预后极差。近年来，恶性黑色素瘤相关的研究进展迅速，已经发现遗传和免疫因素与恶性黑色素瘤的发生、发展密切相关，这为恶性黑色素瘤的靶向和免疫治疗奠定了基础。不断的新药临床研究取得了重要临床成果。该文就此进行了综述。

索拉非尼在中晚期肝癌的临床应用进展

肝细胞癌（肝癌）是常见的恶性肿瘤，其肿瘤相关性死亡率高，手术切除是目前肝癌治疗的首选方法。但大多数肝癌患者在诊断时已不适合手术治疗，预后差；系统化学疗法也被认为不能延长晚期肝癌的生存期。索拉非尼是一种口服的多靶点多酪胺酸激酶抑制剂，近年来被临床研究证实能改善晚期肝癌患者生存期。因此，其在肝癌患者中的应用备受关注。现就索拉非尼在中晚期肝癌的临床应用进展作一综述。

Initiation of parenteral nutrition in critically ill children

Malnutrition is directly related to the outcomes of critically ill children. Providing ideal nutritional treatment can reduce the high catabolic state caused by the critically ill, reduce oxidative damage and regulate immune response, then improving clinical prognosis. Optimized nutritional supply for critically ill children has been transformed from auxiliary support to one of the important treatment methods. Enteral nutrition is the preferred way to provide nutrition, but parenteral nutrition is the only method of supplement and replacement when the supply of enteral nutrition is insufficient or deficient. This article reviews the timing of parenteral nutrition initiation, protein and amino acids in parenteral nutrition, the mechanism of possible adverse effects in early parenteral nutrition, and issues related to parenteral nutrition in premature infants, in order to help clinicians in pediatric intensive care unit improve the evaluation and management of parenteral nutrition use.

Current Status of Treatment and Progress of Radiotherapy for Local Recurrence of Rectal Cancer

肾脏癌肉瘤一例

成人肾恶性横纹肌样瘤1例

血管肌纤维母细胞瘤1例并文献复习

目的:检索有关血管肌纤维母细胞瘤的文献。方法:检索中国期刊全文数据库、中文期刊全文数据库、万方数字化期刊全数据库。结果:检索的所有文献中血管肌纤维母细胞瘤均以个案报道,主要为女性,发病部位大多位于外阴,其次为阴道、宫颈、腹股沟,也有男性阴囊、腹股沟以及1例口底区的报告。结论:血管肌纤维母细胞瘤多为良性病变,彻底手术切除后无复发,但也有复发及恶变报道,应做长期随访观察。

胰腺神经内分泌肿瘤的治疗进展

胰腺神经内分泌肿瘤（PNET）是来源自胰腺多能神经内分泌干细胞的一种罕见的胰腺肿瘤，临床表现复杂多样，病程缓慢, 最终发生转移致死。PNET分为功能性和非功能性，目前治疗有手术、化学疗法、放射治疗、介入、生物治疗以及分子靶向药物治疗，近年生物治疗及分子靶向药物治疗在研究中显示出了良好疗效。根据国内外文献及最新临床试验研究进展，现就PNET治疗进展进行综述。

Influence of Segment Number on the Planning of Intensity-modulated Radiotherapy for Postoperative Adjuvant Radiotherapy for Rectal Cancer

【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.

膀胱小细胞癌一例

【摘要】　目的　总结膀胱小细胞癌的诊断及治疗。　方法　2009年8月1例行根治性膀胱切除、回肠代膀胱术患者经病理学、免疫组织化学检查确诊为膀胱小细胞癌。患者接受EP治疗方案治疗。　结果　治疗4周期后，复查CT未见转移，无Ⅲ~Ⅳ级毒副反应。　结论　膀胱小细胞癌需依靠病理学及免疫组织化学检查确诊，治疗目前参考小细胞肺癌治疗方案，以化学疗法为主，复习文献得出有无手术切除并不影响膀胱小细胞癌患者的预后，靶向药物的治疗尚需进一步研究。