老年肺癌的發(fā)病在逐漸地增加，特別是非小細(xì)胞肺癌，但研究老年肺癌和接受治療老年肺癌偏少，目前對老年肺癌的治療多從回顧性研究得出的結(jié)論。老年肺癌手術(shù)治療時，充分考慮到患者的術(shù)前功能狀態(tài)尤其是心肺功能狀態(tài)和合并癥，微創(chuàng)的手術(shù)老年患者更合適。對于老年患者器官儲備功能的降低和合并癥多，對化療的耐受能力降低，化療能否給患者帶來生存好處，采取單藥還是雙藥化療是臨床討論的問題還需要進(jìn)一步研究。老年容易發(fā)生放射行肺炎和放射行食管炎，放療時老年患者具有與年輕人不同的耐受量和體積當(dāng)接受。對老年周圍性肺癌放療取得良好效果，對老年中央型肺癌采用調(diào)強(qiáng)或適形放療多野放療會增加了放射行肺炎的可能性，是否帶來生存好處還沒有被證實。靶向治療藥物的毒副反應(yīng)較小，但其費用高反應(yīng)率低，僅少數(shù)患者能夠得到治療好處。對于咳血癥狀比較明顯的，可采用介入治療?？傊瑢夏攴切〖?xì)胞肺癌患者治療前需要進(jìn)行全面的老年評估，還需要更多研究。
【摘要】 目的 探討磁共振動態(tài)增強(qiáng)掃描及磁共振彌散加權(quán)成像（diffusion weighted imaging，DWI）對肝癌經(jīng)導(dǎo)管動脈內(nèi)化學(xué)栓塞（transcatheter arterial chemoembolization，TACE）治療后的腫瘤殘余及復(fù)發(fā)的判斷價值?！》椒ā?009年1月-2010年10月，對28例經(jīng)證實的肝癌患者在TACE治療前、治療后3~7 d及治療后1~2個月、3~6個月行磁共振動態(tài)增強(qiáng)及DWI掃描，動態(tài)測量表觀彌散系數(shù)（apparent diffusion coefficient，ADC）值，與數(shù)字減影血管造影（digital substraction angiography，DSA）檢查對照，評價動態(tài)增強(qiáng)掃描及DWI對腫瘤殘留或復(fù)發(fā)的檢出能力。〖HTH〗結(jié)果 對腫瘤殘余及復(fù)發(fā)的顯示，動態(tài)增強(qiáng)掃描靈敏度為90.0%，特異度為96.9%；DWI靈敏度為96.7%，特異度為93.8%；動態(tài)增強(qiáng)掃描與DWI相結(jié)合的靈感度為100.0%，特異度為99.5%；DSA靈敏度和特異度分別為96.7%、100.0%。TACE治療前所有腫瘤實質(zhì)的ADC值為（1.134±0.014）×10-3 mm2/s；TACE治療后3~7 d ADC值為（1.162±0.016）×10-3 mm2/s；TACE治療后1~2個月碘油沉積較好，無明顯殘余或復(fù)發(fā)病灶的ADC值為（1.175±0.015）×10-3 mm2/s，3~6個月后隨訪病灶A(yù)DC值為（1.179±0.017）×10-3 mm2/s；TACE治療后1~2個月碘油沉積不完全或無明顯沉積病灶A(yù)DC值為（1.147±0.016）×10-3 mm2/s，3~6個月后隨訪病灶實質(zhì)平均ADC值（1.142±0.012）×10-3 mm2/s?！〗Y(jié)論 將動脈增強(qiáng)掃描與DWI相結(jié)合可提高對TACE治療后肝癌殘余及復(fù)發(fā)判斷的靈敏度及特異度；對腫瘤組織平均 ADC值的動態(tài)測量、觀察可及早判斷腫瘤復(fù)發(fā)的可能性?！続bstract】 Objective To evaluate the dynamic contrast-enhanced MRI and diffusion weighted imaging (DWI) in judging the remnant and recurrence on hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE). Methods Between January 2009 and October 2010, 28 patients with HCC underwent dynamic contrast-enhanced MRI and DWI before and after TACE 3-7 days, 1-2 months and 3-6 months, respectively, and the apparent diffusion coefficient (ADC) value of the tumor were also measured at above mentioned time points. The sensitivity and specificity of dynamic contrast-enhanced MRI and DWI in diagnosis of residual tumor and recurrent cancer was qualitatively evaluated by comparing with the DSA results. Results Compared with DSA, the sensitivity and specificity of dynamic contrast-enhanced MRI were 90.0% and 96.9% by revealing the remnant and recurrence of HCC, while the sensitivity and specificity of DWI were 96.7% and 93.8% respectively. Combining dynamic contrast-enhanced MRI and DWI the sensitivity and specificity were improved to 100.0% and 99.5%, respectively. The mean ADC value of tumor before and after 3-7 days of TACE were (1.134±0.014)×10-3 and (1.162±0.016)×10-3 mm2/s, respectively. The mean ADC value of tumor without and with remnant and recurrence after 1-2 months and 3-6 months follow up were (1.175±0.015)×10-3, and (1.179±0.017)×10-3 mm2/s; (1.147±0.016)×10-3 and (1.142±0.012)×10-3 mm2/s, respectively. Conclusions Combining dynamic contrast-enhanced MRI and DWI could improve the sensitivity and specificity to detect the remnant and recurrence of HCC after TACE. Measuring the ADC value during follow up of HCC patients after TACE could predict the probability of tumor recurrence.