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Progression and challenge of therapeutic strategies in neovascular age-related macular degeneration

Choroidal neovascularization (CNV) is the key characteristic of neovascular age-related macular degeneration (nAMD), and the effective therapy is intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents based on clinical and basic research. In the meantime the challenge is how to further improve the inhibiting effect for CNV and visual function of anti-VEGF treatment on nAMD. The new strategy and drug delivery devices for anti-VEGF treatment will optimize the clinical scheme. From bench to bedside, the research on targeted treatment of angiogenesis brings the bloom of nAMD medical therapy.

脉络膜黑色素瘤治疗方案的选择

脉络膜黑色素瘤是成年人最常见的原发性眼内恶性肿瘤，是致死的最主要原发性眼内疾病。近20来，以美国及加拿大学者为主要成员的眼部黑色素瘤协作组，对该肿瘤的治疗方式的选择进行了大量的临床研究，有许多新的认识。 (中华眼底病杂志, 2006, 22: 214-216)

Therapeutic effects of eye-retaining treatment for choroidal melanoma

Objective To evaluate the therapeutic effects of treatments of eye-retaining and enucleation for choroidal melanomas. Methods The clinical data of 44 patients (44 eyes) with choroidal melanomas after eye-retaining treatments and enucleation surgery were retrospectively analyzed. The metastasis, retention rate of eyeball after eye-retaining treatment, and visual acuity prognosis were observed and analyzed. In 44 eyes treated by eye-retaining therapy, transpupillary thermotherapy (TTT) was performed primaryly on 7 (15.9%), 106 Ru brachytherapy on 25 (56.8%), and local resection of tumor combined with 106 Ru brachytherapy on 12 (27.3%).The average follow-up period was 13.3 months. Results Forty-four patients had no melanoma metastasis during the follow-up period. In 39 patients (88.6%) who had their eyes retained successfully, the retention rate of eyeball was 100%, 92.9%, and 83.3% in 6, 14, and 24 eyes with small, middle, and large tumor, respectively. In the patients treated by eye-retaining therapy, the visual acuity was ge;0.3 in 11 (28.2%), ge;0.05-＜0.3 in 18 (46.2%), and ＜0.05 (25.6%) in 10 eyes. Conclusions 106 Ru brachytherapy and transpupillary thermotherapy are effective treatments for small and medium-sized choroidal melanomas; some selected cases with large choroidal melanomas was treated with local resection of tumor combined with106 Rubrachytherapy. However, longer followup will be necessary to assess if this treatment has a better comprehensive outcome, compared with enucleation surgery. (Chin J Ocul Fundus Dis, 2006, 22: 150-153)

Priliminary observation on choroidal melanoma treated by plaque radiotherapy

Objective To observe the therapeutic effect of plaque radiotherapy (PRT) on choroidal melanoma. Methods PRT was performed on 21 patients (21 eyes) with chroidal melanoma who had been examined by ophthalmoscopy, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), and B-scan echography. The visual acuity was le;0.05 in 3 eyes, 0.06-0.2 in 4 eyes, and ge;0.3 in 14 eyes before the treatment. Choroidal melanoma, round or oval brown solid hunch, was located at the area around macula in 7 eyes, around the optic disc in 7 eyes, at or near the vascular arcade in 5 cases, and at the periphery in 2 eyes. The maximum length、width and thickness of tumor was 13 mm, 11.6 mm, and 9.59 mm. The isotope we used was125I, and the quantum of designed radiation was 100-120 Gy. Fourteen patients with choroidal melanoma at the macular area or around the optic disc underwent plaque radiotherapy associated with transpupillary thermotherapy (TTT). The average follow-up duration was 12 months with the longest duration of 3 years. The basis and thickness (height) of tumors were measured by B-scan echography. The aggrandizement of the tumor would be regarded if the height increased 15% or the basis boundary aggrandized 250mm. Results The visual acuity after the treatment decreased in 9 eyes, remained unchanged in 10, and increased in 2. The dimension of tumo increased in 6 eyes, remained unchanged in 12, and decreased in 3. The complication was vitreous hemorrhage in 2 eys, vascular occlusion in 1, branch retinal venous occlusion in 1, macular pucker in 1, retinal hemorrhage in 3, partial optic atrophy in 3, neovascular glaucoma in 1, and extraction of eye in 3. Conclusion The domestic plaque design is effective on choroidal melanoma, and is of a sort on the thick tumor and the tumor located at macula or beside the optic disc. (Chin J Ocul Fundus Dis, 2006, 22: 157-160)

鼻咽癌放射治疗后视神经视网膜病变六例

碘-125粒子支架植入治疗晚期食管癌

目的 探讨附有放射碘125(125I)粒子的机织式支架植入治疗晚期食管癌的效果, 总结临床经验，以期为晚期食管癌患者的合理治疗提供临床依据。 方法 37例晚期食管癌患者应用附有125I粒子的机织式支架植入治疗，术中、术后观察随访支架植入成功率及并发症的发生率, 比较术前与术后3个月食管病变长度和白细胞计数的变化。 结果 37例患者手术过程顺利，支架植入成功率均为100%，仅3例患者胸部有明显疼痛不适感，经对症处理后缓解；随访6个月，随访33例，失访2例，死亡1例，因年龄偏大，体质较弱死亡。术后3个月，吞咽困难缓解率为100%，治疗后较治疗前食管病变长度明显缩小(Plt;0.05)，而白细胞计数的变化差异无统计学意义 (Pgt;0.05)。 结论 附有125I粒子的机织式支架能明显改善吞咽困难症状，还可对肿瘤进行组织间放疗， 明显改善患者术后的生存质量。

Comparison of the Outcome of Complete Excision followed by Threedimensional Conformal Radiation Therapy and Adjuvant Chemotherapy versus Adjuvant Chemotherapy Alone in the Treatment of Patients with Stage ⅢA-N2 Non-small Cell Lung Cancer

目的：探讨ⅢA-N2期非小细胞肺癌（NSCLC）完全切除术后三维适形放疗联合辅助化疗疗效。方法:对48例ⅢA-N2期NSCLC完全切除术后患者，术后病理为腺癌18例、鳞癌27例、腺鳞癌3例，按信封法随机分为放疗组（24例）与非放疗组（24例）。放疗组采用术后三维适形放疗，4～5个非共面野，以90%～95%等剂量曲线包绕PTV，每次2 Gy，1次/日，5次/周，共照射25次，总剂量DT 50 Gy，放疗后予TP方案化疗3~4周期；非放疗组术后予TP方案化疗3~4周期。结果：放疗组1、2、3年生存率分别为95.8%、79.2%、62.5%，非放疗组分别为91.7%、58.3%、37.5%；放疗组1、2、3年无病生存率分别75.0%、58.3%、45.8%，非放疗组分别为54.2%、41.7%、25.0%；放疗组与非放疗组3年胸腔内复发分别12.5%和37.5%；放疗组与非放疗组中位生存时间分别为28个月和18个月；放疗组白细胞减少、急性放射性肺炎、气管炎发生率分别为25.0%、8.3%、12.5%，均为Ⅰ或Ⅱ级；Ⅰ级急性放射性食管炎发生率为20.8%。结论：ⅢA-N2期非小细胞肺癌完全切除术后三维适形放疗联合辅助化疗，可以降低患者胸腔内肿瘤复发、提高术后生存率。

125I 粒子植入治疗复发、转移性纵隔恶性肿瘤51例

目的 探讨CT引导125I粒子植入治疗复发及转移性纵隔恶性肿瘤的技术方法和疗效，以提高纵隔肿瘤的局部控制率。 方法 对51例复发及转移性纵隔恶性肿瘤患者在CT引导下行125I粒子植入治疗。前纵隔病变采用胸骨旁入路直接穿刺和经胸骨共轴针法植入粒子，主动脉窗、主动脉弓旁病变采用左前胸骨旁入路，气管上腔静脉间隙之间的病变采用右后经胸壁入路，隆突前病变采用经后胸壁入路或前胸壁入路，隆突下病变采用经右胸壁和脊柱入路。术后采用CT检查随访，以观察患者临床指标改善情况。 结果 围手术期无手术死亡和严重并发症发生，其中有41例患者一次成功植入125I 粒子，粒子分布满意；7例术后3 d在CT引导下成功植入125I 粒子；3例125 I 粒子植入失败。术后发生痰中带血6例，少量胸腔内出血3例，CT检查发现有少量气胸 7例, 经观察未做进一步处理自愈。完成125I 粒子植入的48例患者，术后1个月复查CT，完全缓解（CR）26例，部分缓解(PR)14例，无变化（AC）5例，出现新的病灶(PD)3例，总有效率83.33%（40/48）。随访51例,随访时间12～60个月，中位随访期26个月。1年局部控制率为93.75% (45/48)。 结论 在CT引导下采用不同穿刺方法植入放射性 125I 粒子治疗纵隔复发、转移性恶性肿瘤，安全、微创，并发症发生率低，疗效肯定。

放化疗与单纯放疗治疗小细胞肺癌的疗效比较

【摘要】 目的 比较放化疗与单纯放疗治疗小细胞肺癌的疗效差异。方法 2007年1月—2008年6月收治小细胞肺癌患者48例。在患者知情同意的前提下,随机分为放化疗结合组27例和单纯化疗组21例。观察并比较两组的治疗效果。结果 放化疗结合组和单纯化疗组总有效率分别为88.9%(24/27)和66.7%(14/21),放化疗结合组高于单纯化疗组(Plt;0.05)。放化疗结合组和单纯化疗组1年生存率分别为74.1%(20/27)和57.4%(12/21),放化疗结合组高于单纯化疗组(Plt;0.05)。结论 放化疗综合治疗小细胞肺癌可改善患者临床症状和生活质量,延长生存期。

Treatment for radiation retinopathy of uveal melanoma undergone radiotherapy: the current situation

Radiotherapy is the prior treatment for uveal melanoma, but a major problem confronted most of the patients is radiation retinopathy, which accompanied with severe visual loss and secondary enucleation potential. There is no optium choice and normative strategy so far, the intraocular melanoma society has focused on application of anti-vascular endothelial growth factor drugs injection and glucocorticoids. This article reviews a series of potential managements for radiation retinopathy and its further stage .