Long-Term Results of PET-Guided Radiation Therapy in Patients with Advanced-Stage Diffuse Large B-Cell Lymphoma Treated with R-CHOP in British Columbia
Ciara L. FreemanKerry J. SavageDiego VillaDavid W. ScottLine SrourAlina S. GerrieM. J. BrownGraham W. SlackPedro FarinhaBrian SkinniderChristina ParsonsTom PicklesR. Petter TonsethDon WilsonJoseph M. ConnorsLaurie H. Sehn
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CTによる膀胱腫瘍浸潤度判定をより客観的なものとする目的で, 新たに理想膀胱外壁線および腫瘍根部径 (W)-縦径 (H) 比を設定して各浸潤度別に比較検討し, 以下の検討結果をえた. (1) CTによる形態診断で, 小乳頭状型, 乳頭状有茎性型, 乳頭状無茎性型を示したものはすべて Stage B1以下であつた. 広基結節型を示した23例中19例は, CTによる判定通り広基結節型 Stage B2以上であつたが, 残りの4例は摘出標本では乳頭状無茎性型 Stage B1であつた. (2) 体位変換時の腫瘍変位性は, 乳頭状有茎性型形態を示したもののみに認められ, そのすべてが Stage B1以下であつた. (3) 理想膀胱外壁線外への腫瘍突出は広基結節型を示した Stage C 以上の全例に認められた. また, 従来膀胱壁外には突出しないとされてきた Stage B2の6例中4例に認められた. 突出した腫瘍根部の外壁を比較すると Stage B2ではその突出部の性状は平滑であつたが, Stage C 以上の場合は不整であつた. (4) W/H比に関しては, 乳頭状型を呈した Stage B1以下と広基結節型を呈した Stage B2以上は1.2で明瞭に判別できた.以上より作成したCTによる膀胱腫瘍浸潤度判定基準により, Stage B1以下では37例中26例 (70%), Stage B2以上では19例中16例 (84%). 特に膀胱内注入物質として空気を用いた場合, Stage B2以上において15例中15例 (100%) と非常に高い一致率が得られた.本判定基準による膀胱腫瘍浸潤度のCT診断は, 従来は極めて困難であつた深層浸潤性腫瘍の各 Stage の判別診断を可能とし, 臨床上極めて有用なものと考える.
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Controversy has recently arisen as to whether diffuse intermediate lymphocytic lymphoma (ILL) should be considered a low-grade or an intermediate-grade non-Hodgkin's lymphoma for clinical purposes. Therefore, the authors performed a clinicopathologic study to determine the biologic course of diffuse ILL (40 cases) and compared it with small lymphocytic lymphoma (SLL; 51 cases) and diffuse small cleaved cell lymphoma (DSCCL; 14 cases). They found that patients with diffuse ILL having pseudofollicular proliferation centers (PC) had a significantly longer median survival (84 months) than those without PC (46.5 months; P = 0.03). The median survival of patients with SLL was 72 months, whereas those with DSCCL had a median survival of only 18 months. Based on these findings, the authors conclude that diffuse ILL with PC should be included in the low-grade category of SLL for clinical purposes, whereas diffuse ILL without PC (true diffuse ILL) should be considered an intermediate-grade non-Hodgkin's lymphoma. True diffuse ILL is similar to centrocytic lymphoma in the Kiel classification and should be accorded a similar status in a modified Working Formulation.
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Cutaneous diffuse large B-cell lymphoma, leg type, is a malignant lymphoma of intermediate behavior, occurring mostly on leg(s) of elderly patients. This chapter describes the clinical features, histopathology, immunophenotype, molecular genetics, treatment and prognosis of diffuse large B-cell lymphoma, leg type. It is a matter of discussion whether diffuse large B-cell lymphoma, leg type, is a specific entity per se, or does simply represent a primary cutaneous variant of diffuse large B-cell lymphoma, unspecified. In fact, there are more similarities than differences between these groups, and it has been suggested that diffuse large B-cell lymphoma, leg type, should not be considered as a separate entity, but rather classified within the group of diffuse large B-cell lymphoma, unspecified. It must be remembered that diagnosis of cutaneous diffuse large B-cell lymphoma, leg type, is made only upon negative staging investigations, as any extracutaneous diffuse large B-cell lymphoma may involve the skin secondarily.
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Guru-shishya parampara (with due respect to its importance as an established form of knowledge-transfer system and its historical references) is in a way a register of a life-cycle of a trained (neo-classical) dancer. This system has a history of exchange for those specialists who claim the designation of a guru and all who register themselves as shishya under specific gurus. This chapter attempts a critical understanding of the so-called sacred duty of transmission of knowledge as a wat to ensure livelihood and survival. With the help of the case study of Amala Shankar (1919–2020) and her modern institution, the chapter looks at the Uday Shankar India Culture Centre as the alternate space for creating a value for the system of knowledge transfer beyond the traditional guru-shishya parampara.
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This chapter contains sections titled: Introduction The great debate: surgery versus radiotherapy Surgery plus adjuvant radiotherapy How does radiotherapy work? Methods of radiotherapy administration Radiotherapy simulation and planning Radiotherapy treatment factors Optimising radiotherapy treatment Treatment-related toxicities Acute radiotherapy toxicities Late radiotherapy toxicities Second malignancies Radiotherapy and quality of life Conclusion Frequently asked questions Resources References
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Objective:To study on whether radiotherapy affects on T cell subgroups,and to research on the effects of immunoenhancing agents on the immune side effects of radiotherapy.Methods:Sixty-six malignant tumour patients were divided into two groups,radiotherapy alone and radiotherpay plus immunoinhancing agents therapy groups.All patients were subjected to high energy X-rays and electronic rays outer local reginal therapy.T cell subgroups levels were measured before and after the radiotherapy.Results:CD 3,CD 4 and CD 8 decreased significantly after radiotherapy (P0.05) in radiotherapy alone group.There were no differences in CD 3,CD 4 and CD 8 before and after radiotherapy in the group of radiotherapy plus immunoinhancing agents therapy.Conclusions:Radiotherapy may cause the decrease in T cells of all subgroups and immunoinhancing agents may antagonize the side effects of radiotherapy. [
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地方性甲状腺腫は臨床, 病理学的に複雑な経過を示し, 疫学的, 病理学的発生論や治療の選択に多くの難題が残されている. 著者は本症の病期検討および妥当な病期分類がこれらの検索, 解明にきわめて有用であると着目し, 甲状腺剔出を行なった地方性甲状腺腫336例を臨床, 病理学的に精査し下記の結果をえた. 1) 地方性甲状腺腫は臨床的, 病理学的経過からStage 1;過形成期, Stage 2;腫大期, Stage 3;結節形成期と分類できた. 2) 本症は病期の進行に伴い病悩期間は長くなり, 甲状腺腫は増大し種々の局所圧迫症状をみるが, 合併症がなければ全身的, 臨床生化学的所見はほぼ正常である. 3) 臨床, 病理学的に本症はStage 1からStage 2さらにStage 3に進行し, Stage 3は終末期である. 4) 病変の占居部位はStage 1では両葉性, Stage 2では両葉性と単葉性がほぼ等しく, Stage 3では単葉性が多い点からもStageの進行度を裏付けられる. 5) 336例のうち男性39例, 女性297例, 男女比1:7.6で, 発生のピークは女性では20才から30才代, 男性は30才から40才代であった. 6) 手術適応例は若年者より成人に多く, 女性は男性より著しく多い. ヨード治療の効果が若年者ほど良好で, 男性は女性よりもヨード感受性が高いためである. 7) Stage 3の9.4%に甲状腺機能亢進症 (4.03%), 腺腫 (1.34%), 甲状腺癌 (4.03%) などの共存疾患がみられた. 8) ヨード治療はStage 1では効果的であるがStage 2では無効でStage 3に進行し, 種々の合併症を起こすこともあり, Stage 2における手術が望ましい.
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