食管癌是全球范围内常见的恶性肿瘤之一,包括鳞状细胞癌和腺癌,其特点是预后差。随着诊疗技术的发展,食管癌患者生存率略有提高,多原发恶性肿瘤也越来越普遍。放射治疗是食管癌治疗基石,也是多原发恶性肿瘤的病因之一。本研究旨在综述目前食管癌多原发恶性肿瘤的临床特征及放疗相关多原发恶性肿瘤的研究现状。Esophageal cancer is among the most common malignant tumors globally, encompassing both squamous cell carcinoma and adenocarcinoma, and is characterized by a poor prognosis. With advancements in diagnostic and therapeutic technologies, the survival rate of patients with esophageal cancer has seen a slight improvement;concurrently, the incidence of multiple primary malignancies is becoming increasingly prevalent. Radiation therapy serves as the cornerstone of esophageal cancer treatment and is also a contributing factor to the emergence of multiple primary malignancies. This study aims to review the current clinical characteristics of multiple primary malignancies associated with esophageal cancer, as well as the existing research on the relationship between radiotherapy and these tumors.
非小细胞肺癌(NSCLC)患者中,表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)已成为一线治疗方案。但联合治疗时,间质性肺疾病(ILD)风险备受关注。单药治疗时,不同代际EGFR-TKI的ILD风险特征各异,第一代在亚洲人群风险较高,第三代与剂量、治疗阶段及患者基线肺功能状态关联。联合治疗中,免疫检查点抑制剂增加重度ILD发生率,抗血管生成药物或序贯放疗可降低风险。临床管理策略如风险分层、剂量调整及跨代换药等逐步完善,提升了ILD防控效率。未来需大规模前瞻性研究明确不同药物组合及治疗顺序对ILD风险的长期影响。本文旨在综述EGFR-TKI不同代际及联合治疗的ILD风险研究现状。In patients with non-small cell lung cancer (NSCLC), epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) have become first-line therapeutic agents. However, the risk of interstitial lung disease (ILD) during combination therapies has attracted significant attention. For monotherapy, different generations of EGFR-TKIs exhibit distinct ILD risk profiles: first-generation drugs show higher risks in Asian populations, while third-generation agents demonstrate correlations with dosage, treatment phases, and patients’ baseline pulmonary function status. In combination therapies, immune checkpoint inhibitors increase the incidence of severe ILD, whereas anti-angiogenic agents or sequential radiotherapy may mitigate risks. The optimization of clinical management strategies—including risk stratification, dosage adjustments, and cross-generation drug substitution—has progressively enhanced ILD prevention and control. Future large-scale prospective studies are required to clarify the long-term impacts of various drug combinations and treatment sequences on ILD risk. This review aims to summarize current research on ILD risks associated with different EGFR-TKI generations and their combination therapies.
跟腱作为人体最强健的肌腱,跟腱在运动功能中承担着核心力学负荷,却因其独特的解剖特性成为高发断裂部位。尽管其损伤机制尚未完全阐明,但现有证据支持“暴力牵拉–退行性变–累积微损伤”三联作用假说。近年来,全球范围内跟腱断裂发病率持续攀升,但其最佳治疗策略仍存争议。传统观念(2005年前)因非手术治疗再断裂率较高及康复周期漫长,多推荐手术修复以降低再断裂风险。然而,随着早期功能康复体系的革新,现代保守治疗通过动态支具联合渐进性负重训练,将再断裂率显著下降,且治疗后1年的总跟腱断裂评分与手术组无统计学差异(P > 0.05)。同时,手术相关并发症风险促使临床决策向非手术方案倾斜,尤其适用于老年患者或合并代谢性疾病人群。本综述系统梳理非手术治疗的最新循证证据,旨在为临床医生优化治疗方案提供科学依据。The Achilles tendon, the strongest tendon in the human body, plays a central biomechanical role in locomotion but is prone to rupture due to its unique anatomical characteristics. Although its injury mechanisms remain incompletely understood, existing evidence supports the triple mechanism hypothesis of “violent traction-degenerative changes-cumulative microtrauma”. Despite the rising global incidence of Achilles tendon ruptures in recent years, the optimal treatment strategy remains controversial. The traditional paradigm (before 2005) favored surgical repair to mitigate re-rupture risks associated with higher re-rupture rates and prolonged recovery in nonoperative approaches. However, with the innovation in early functional rehabilitation protocols, modern conservative treatment with dynamic bracing combined with progressive weight-bearing training has significantly reduced re-rupture rates. At 1-year follow-up, nonoperative treatment demonstrates no significant difference in the Achilles tendon total rupture score compared to operative groups (P > 0.05). Furthermore, surgical complication risks have prompted clinical decision-making toward nonoperative strategies, especially for elderly patients or those with metabolic comorbidities. This review synthesizes the latest evidence on nonoperative management to provide clinicians with evidence-based insights for optimizing therapeutic decision-making.
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