食道鳞状细胞癌术后辅助治疗研究进展
毛伟敏 院长 浙江省肿瘤医院
食道癌居中国恶性肿瘤发病的第五位，其中鳞状细胞癌约占90%以上。手术为可切除食道鳞状细胞癌的主要治疗手段，但单纯手术的疗效不尽如人意，多学科综合治疗的开展有可能进一步提高其疗效。近年来，术后辅助化疗、术后辅助放疗及术后辅助放化疗在食道鳞状细胞癌中进行了深入的研究，以期降低肿瘤复发及改善患者生存。到目前为止，尚没有随机临床研究明确提示食道鳞状细胞癌辅助化疗、辅助放疗或辅助放化疗较单纯手术治疗可显著延长患者总生存。大量的术后辅助治疗资料表明，只有部分选择性的局部晚期的食道鳞癌患者才能真正从术后辅助放疗或辅助化疗中获益；术后辅助放化疗的小样本Meta分析结果令人鼓舞。今后食道癌的临床研究应重视如何在减轻治疗相关副作用和改善患者生活品质的基础上个体化选择治疗方案。有必要开展更多的多中心随机临床试验获得共识，从而使食道癌患者真正从现代的多学科综合治疗中获益。
Management of esophageal cancers-A holistic approach using minimally invasive esophagectomy (MIE) after concurrent chemoradiotherapy
徐中平 主任 台中荣民总医院外科部主任
Background: To investigate the efficacy and safety of reverse sequence procedures in performing MIE (minimally invasive esophagectomy) for esophageal cancers using a holistic approach.
Methods: Between 2008 and 2014, 314 consecutive esophageal cancer patients underwent surgical resection were enrolled. Among these, 156 cases received 3-phase video-assisted MIE procedures which included 103 reverse sequence MIE (excluded 2 conversions, and 6 da-Vinci operations). Neoadjuvant CCRT（cisplatin/5-FU+5040 cGy）were performed in 146 cases.
Results: In the reverse MIE group, the mean operation time of the reconstruction stage and resection stage were 261.0+43.5 minutes and 177.0+47.5 minutes, respectively. Mean lymph nodes retrieved and blood loss were 37.8+14.5 and 228+164 cc, respectively. There were no hospital mortalities, and the cervical anastomotic leak occurred in 15 patients (16.7%). Complete pathologic response was obtained in 28 patients (31.1%), and the overall 5-yr survival rates were 40.1%.
Conclusions:Reverse sequence MIEs are efficient and safe procedures in treatment of esophageal patient cancers.
结直肠癌Multidisciplinary Team (MDT)的临床实践
魏少忠 院长 湖北省肿瘤医院
湖北省肿瘤医院自2009年以来，较早开展结直肠癌等病种的多学科团队诊疗，本文拟先容我院结直肠癌多学科团队诊疗的临床实践经验，分析其成功与不足，为结直肠癌MDT发展提供借鉴。方法：分析我院近年来开展MDT的组织架构和运行情况，总结MDT经验，分析MDT医疗效果和管理效益。结果：合理的组织架构是结直肠癌MDT良好运作的基础，团队领导者和秘书的工作非常重要，各学科专家组需要分工明确。其次，MDT还需要根据医院具体情况确定结直肠癌诊治指南，通过综合和细化的规章制度来规范诊治流程，并且建立相关学科规范。然后，对全院从事结直肠癌的工作人员进行培训十分必要。多学科团队的工作在我院现有制度保障下，能够得到良好的实施和实行。对于患者达到治疗的个体化，缩短了诊疗的时间，对于医生提高了个人诊疗水准和技能，对于医院促进了各学科的发展和交流。MDT的发展使医患双方同时获益。结论: MDT是现代医疗模式的转变，医学多学科交叉发展的需要，合理的组织和运作将会提高肿瘤诊疗水准，最终将会最大限度地惠及广大患者。
Hubei Province Cancer Hospital had an early start of multi-disciplinary team (Multidisciplinary Team, MDT) treatment in colorectal cancer and other diseases since 2009. We here describe the clinical experience of our hospital treatment of colorectal cancer multidisciplinary team, analyzing its success and disadvantages to provide reference for the development of MDT colorectal cancer. Method analysis of organization and organization and operation of the MDT in our hospital was carried out, experiences were summed up, management efficiency and medical effects of MDT were investigated. Result proper organization of colorectal cancer MDT is the basis of a well-functioning, and team leader and secretary is very important, and a clear division is needed between interdisciplinary groups of experts. Secondly, guidelines of MDT should be established according to the specific circumstances. Related disciplines should be set up through standardizing the procedure of diagnosis and treatment with comprehensive and detailed rules and regulations. Then, the training of the hospital staff involved in colorectal cancer care is essential. Multidisciplinary team decisions in our hospital get a good implementation and enforcement under supervision. For patients, individual clinics and skills were improved, and MDT promote the development of the hospital and exchanges in various disciplines. The development of MDT simultaneously benefit both doctors and patients. Conclusion MDT is the transformation of modern medical care, involves the Multidisciplinary medicine. Reasonable organization and operation will improve the level of diagnosis and treatment of tumor, which would eventually benefit the majority of patients.
Cancer Clinical Trials in Singapore and Practices
张元吉 教授 Professor, Department of Oncology, Johns Hopkins University
Cancer is the leading cause of death in Singapore for more than 2 decades. It accounted for 30.1% of all death of Singaporeans in 2012, and was the second most common cause for hospital admissions. Singapore government has mandated report for every new cancer patients diagnosed since 1968. Although the cancer incidences have slightly reduced in the last few years, the actual number of cancer cases has increased due to growth and aging of the population. Public healthcare institutions and private sectors have placed important roles for conducting cancer trials which facilitate and promote the advance of knowledge, patient care, physician education as well as the development of local health care industry including pharmaceutical and biotech companies. As such, cancer clinical trials are the daily practice fabric by physicians providing cancer care. Almost in every public and private hospital there is clinical research office and independent IRB following the international guidelines and standards such as Association for the Accreditation of Human Research Protection Programme (AAHRPP). Currently, there are several hundreds of cancer clinical trials on going in Singapore including all phases of studies as well as translational research, such as pharmacogenetics, pharmacogenomics, circulating tumor DNA, vaccines, etc..
肿瘤微创治疗与多学科综合治疗
吴沛宏 教授 中山大学附属肿瘤医院医学影像与微创介入中心主任
微创医学和生物医学已成为21世纪医学发展的两大趋势和热点，微创治疗精确定位、精确治疗，创伤小、恢复快、痛苦轻，疗效确切。继以全身水准的生物基因治疗和分子靶向治疗，通过肿瘤宿主防御机制或生物制剂的作用以调节机体自身的生物学反应，抑制或消除肿瘤，减少了肿瘤的复发，改善了患者的生存品质。肿瘤微创治疗与多学科综合治疗的特点主要体现在以下三个方面：（1）肿瘤微创治疗与多学科的联合应用；（2）根治性肿瘤微创治疗；（3）人性化、理性化治疗。微创治疗联合生物治疗和分子靶向治疗的新模式将成为新世纪肿瘤治疗的重要组成部分。
Minimally invasive therapy and bio-immunotherapy are recognized as most important directions of cancer treatment in the 21st Century. Minimally invasive therapy is a painless, precise treatment modality that will benefit patients through fast recovery. Sequential bio-immunotherapy, targeted therapy can enhance host immune defense, decrease cancer recurrence and help us improve the quality of patients’ lives. The following are the trends of minimally invasive therapy in the 21st Century: 1. Combined minimally invasive therapy and multidisciplinary therapies. 2. Minimally invasive therapy of radical intent. 3. Therapy with rationality and humanity. The new mode of combined minimally invasive therapy with bio-immunotherapy is expected to be the most important part of cancer treatment in the 21st Century.
Photodynamic therapy (PDT) for lung cancer
Niiza-Shiki Central General Hospital, International University of Health and Welfare and Tokyo Medical University
The history, current status and future of PDT in lung cancer is presented. The increase of lung cancer patients, the high death rate and the increase of medical cost are big problems. The death rate is about 75 to 90%. Although the treatment of this disease is not easy, on the other hand the high quality curative treatment, safe, low invasive and low cost treatments are required for the patients.
Although there are several options for lung cancer treatment, PDT is one of effective treatments for early central type lung squamous cell carcinoma. If the early detection of central type early stages lung cancer is possible, curative results can be obtained by PDT. For curative results it is necessary to detect early stage central type lung cancer. Methodologies for the early detection of lung cancer and the definition of central type early stage lung cancer are presented.
On the other hand since peripheral adenocarcinoma is recently increased significantly throughout world, it will be also necessary to make effective measure by PDT for this peripheral type early stage adenocarcinoma in near future.
Although Photofrin and Lasephyrin as photosensitizer are used at present, it seems that Lasephrin would show better results than Photofrin.
It is expected that PDT for lung cancer treatment will become more sophisticated therapy future. For better photosensitizers, infrared ranged photosensitizers excited by X-ray or Synchrotron radiation for example, will be useful for any stages of cancer. Micelle and nano-particle drugs will be useful more specific tumor photosensitizers. Cancer antibody combined photosensitizer and molecular targeted photosensitizers will be useful for personalized PDT which are expected more accurate PDT.
肺癌的光动力学疗法
Niiza-Shiki Central General Hospital, International University of Health and Welfare and Tokyo Medical University
本文将对肺癌光动力治疗的历史，当前和将来趋势进行讨论。肺癌患者的增加，高死亡率和医疗费用的增加是突出的问题。由于治疗困难，肺癌死亡率大约是75%到90%。因此寻找高质量，安全，低侵袭性和低成本的治疗也是十分必须的。
肺癌的治疗方式有很多，其中光动力治疗是一种有效的治疗早期中心型肺鳞癌的方法。如果早期检测到中心型肺癌，那么光动力治疗可以取得疗效。早期检测肺癌的方法和早期中心型肺癌的定义将被讨论。
另一方面，周围性肺腺癌的数量逐渐增多，将来有必要努力尝试应用光动力治疗治疗这种周围型早期腺癌。
目前，尽管光卟啉和Lasephyrin都用作光敏感剂，但是Lasephyrin的效果比光卟啉更好。
可以期待，肺癌光动力治疗将成为更精确的治疗方式。X光和同步加速器辐射激发红外线光敏感剂将应用于各种分期的肺癌。微泡和纳米颗粒药物将成为更特异的肿瘤光敏感剂。肿瘤抗体结合光敏感剂和分子靶向光敏感剂将对于个体化光动力治疗更有效。（天津医科大学总医院 徐嵩编译）
Genomics of lung cancer
Ramaswamy Govindan, MD,PhD
Professor of Medicine, Division of Medical Oncology,
Washington University School of Medicine
Cancer is essentially a disease of the cellular genome. Recent advances in the sequencing technology and bioinformatics have made it possible to study the genomic landscape of malignant tumors in unprecedented detail. The systemic therapy of non-small cell lung cancer (NSCLC) is moving away from the “one-size fits all” empiric chemotherapy to targeted therapy of specific molecular alternations. We have made significant progress in the treatment of patients with mutations in the Epidermal Growth Factor Receptor (EGFR) and rearrangements involving anaplastic lymphoma kinase (ALK). Studies conducted by The Cancer Genome Atlas (TCGA) project and others have identified a number of new molecular alterations. It is evident now that there is considerable inter and intra tumoral heterogeneity. Ongoing and future studies will shed further light on the clonal architecture, clonal evolution and additional potentially targetable alternations. An up to date review of the known genomic alterations in lung cancer will be discussed in this presentation.
肺癌基因组学
Ramaswamy Govindan, MD,PhD
Professor of Medicine, Division of Medical Oncology,
Washington University School of Medicine
癌症是一种细胞基因组学异常的疾病。近年来，由于测序技术和生物信息学的迅猛发展，癌症疾病的遗传学信息已经被逐渐揭示。非小细胞肺癌的系统治疗已经由“一刀切”的经典化疗转变为针对特异分子改变的靶向治疗。其中，大家对于发生表皮生长因子受体（EGFR）突变和间变淋巴瘤激酶（ALK）重排的非小细胞肺癌患者的治疗取得了显著的进展。癌症基因图谱项目以及其他相关研究也鉴定发现其他新的分子改变位点。大家可以明显看到肿瘤疾病之间和肿瘤组织内的异质性。目前正在进行和未来的研究将逐渐揭示肿瘤克隆结构，克隆生长进化和其他潜在的靶向改变。本次报告将回顾当前已知肺癌基因突变的相关研究。（天津医科大学总医院 徐嵩编译）
