简介：PURPOSE:Weinvestigatethepatternsoffailureinthetreatmentofglioblastoma(GBM)basedonclinicaltargetvolume(CTV)marginsize,dosedeliveredtothesiteofinitialfailure,andtheuseoftemozolomideandintensity-modulatedradiotherapy(IMRT).METHODS:BetweenAugust2000andMay2010,161patientswithGBMweretreatedwithradiotherapywithorwithoutconcurrenttemozolomide.PatientsweretreatedwithCTVexpansionsthatrangedfrom5to20mmusingashrinkingfieldtechnique.PatternsoffailureandtimetoprogressionandoverallsurvivalwerecomparedbasedonCTVmargin,useoftemozolomide,anduseofIMRT.KaplanMeieranalysiswasusedtoestimatesurvivaltimes,andχtestwasusedforcomparisonofcohorts.RESULTS:Forpatientstreatedwith5-,10-,and15-to20-mmCTV,79%,77%,and86%experiencedfailuresinthe60Gyvolume,respectively.Forty-eightpercent,55%,and66%ofpatientswith5-,10-,and15-to20-mmCTVexperiencedfailuresinthe46Gyvolume,respectively.Therewasnostatisticaldifferencebetweenpatientstreatedwith5-,10-,15-to20-mmmarginswithregardto60Gyfailure(P=0.76),46Gyfailure(P=0.51),ormarginalfailure(P=0.73).Eightypercentofpatientsreceivingtemozolomideexperiencedfailuresinthe60Gyvolume.TherewasnoincreasedlikelihoodofmarginalfailuresinpatientsreceivingIMRT(P=0.97).CONCLUSIONS:Moderntreatmenttechniquesincludinguseofconcurrenttemozolmide,limitedCTVmarginsize,andIMRThavenotgreatlychangedthepatternsoffailureofGBM.

简介：Objective:Theaimofthisstudywastoinvestigatethefeasibilityofusingultrasonicscalpelcombinedwithvascularclipinparametrialmanagement,calledlimitedenergyparametrialresection/dissection(LEPRD),inlaparoscopicnerveplane-sparingradicalhysterectomy(NPSRH),amodifiednerve-sparingradicalhysterectomy(NSRH);andtoevaluateitseffectivenessinpelvicautonomicnervepreservation.Methods:FromJuly2012toJanuary2016,257consecutivepatientswithstageIB1toIIA2cervicalcancerwhounderwentNPSRHwereincludedinthisstudy.Patientsweredividedintothreecohortsaccordingtothedifferentparametrialresectionmodality.Theclinical,pathologicalandsurgery-relatedparameterswerecomparedbetweenthethreegroups.Short-andlong-termpostoperativebladderfunctionswereevaluated.Results:LEPRDwasattemptedin94patients,andwassuccessfulin65(69.1%)patients(LEPRDgroup).Theremaining29(30.9%)patientsrequiredbipolarcoagulationafterfailureofvascularclipping(combinedmodalitygroup).Routinebipolarcauterywasusedintheother163patientsduringtheparametrialresection(bipolargroup).ThebloodlossintheLEPRDgroupwassignificantlylowerthanthoseintheothertwogroups(P<0.001).TherateofsuccessfulFoleyremovalonpostoperativeday7wassignificantlyhigherintheLEPRDgroupthaninthebipolargroup(P=0.022).TheincidenceofchronicvoidingdysfunctionwassignificantlylowerintheLEPRDgroupthaninthebipolargroup(P=0.019).Conclusions:ItisfeasibletoperformLEPRDinNPSRHforcervicalcancers.Thiskindoflimitedenergysurgicaltechniqueisassociatedwithlessbloodloss,andleadstoimprovedpostoperativebladderfunction.

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