多西他赛联合奥沙利铂卡培他滨治疗晚期胃癌的临床研究

目的:临床观察多西他赛联合奥沙利铂、卡培他滨治疗晚期胃癌的疗效及不良反应.方法:56例晚期胃癌患者接受多西他赛75 mg/m2,d1,奥沙利铂85 mg/m2,d2,卡培他滨每天1 000 mg/m2,bid,d1～d14,21d为1个周期,化疗2个周期后评价疗效.结果:56例患者均可评价疗效,其中CR 6例(10.7%),PR 30例(53.6%),SD 12例(21.4%),PD 8例(14.3%),总有效率64.3%,中位TTP为6.2个月(3.6～11.8个月),中位OS为11.6个月(5.9～14.6个月).常见不良反应为骨髓抑制、胃肠道反应和外周神经炎,无化疗相关性死亡.结论:多西他赛联合奥沙利铂、卡培他滨治疗晚期胃癌有效率较高,血液学毒性低,近期疗效较好,提高了患者的生活质量.     

多西他赛联合奥沙利铂、卡培他滨一线治疗晚期胃癌临床观察

目的:评价多西他赛(TXT)联合奥沙利铂(OXA)、卡培他滨(Xeloda)治疗晚期胃癌的近期疗效及不良反应.方法:19例晚期胃癌患者接受多西他赛75mg/m2,d1,奥沙利铂85mg/m2,d2,卡培他滨每天1000mg/m2,bid,d1-14,21d为1个周期,化疗2个周期后评价疗效.结果:19例患者均可评价疗效,其中CR 1例(5.3％),PR 10例(52.6％),SD 5例(26.3％),PD 3例(15.8％),总有效率57.9％,中位TTP为5.8个月,中位OS为10.5个月;常见不良反应为骨髓抑制、胃肠道反应、外周神经毒性、脱发且多以Ⅰ-Ⅱ度为主.结论:多西他赛联合奥沙利铂、卡培他滨方案治疗晚期胃癌近期疗效好,不良反应可耐受.     

多西他赛联合卡培他滨和奥沙利铂治疗晚期胃癌45例

[目的]探讨多西他赛联合XELOX（卡培他滨和奥沙利铂）方案治疗晚期胃癌的疗效和毒副反应。[方法]45例晚期胃癌患者接受多西他赛75mg/m^2,d1,卡培他滨每天2000mg/m^2,分2次口服,d1-14,奥沙利铂135mg/m^2,d1,21d为1个周期．至少化疗2个周期评价疗效。[结果]总有效率为57．8％,中位疾病进展时间（TTP）为6．4个月,中位生存期10．1个月。常见毒副反应为白细胞减少、手足综合征和周围神经毒性反应等。[结论]多西他赛联合XELOX方案治疗晚期胃癌疗效明显．患者耐受性较好。     

卡培他滨联合多西紫杉醇和奥沙利铂治疗晚期转移性食管癌的临床观察

目的 观察卡培他滨联合多西紫杉醇和奥沙利铂治疗晚期转移性食管癌的l临床疗效和毒副反应.方法 50例晚期转移性食管癌接受卡培他滨联合多西紫杉醇和奥沙利铂的联合方案化疗.应用卡培他滨(1 000 mg/m2,d1～14)+多两紫杉醇(30 mg/m2,d.)+奥沙利铂(50 mg/m2,d1),21 d为1周期,治疗后2个周期评价疗效和毒副反应.结果 全组50例中,无CR,PR 19例,SD 20例,PD 11例,总有效率为38%.中位肿瘤进展时间3.4个月.主要毒副反应为中性粒细胞减少(38%)、手足综合征(36%)、腹泻(44%),恶心呕吐(56%)、周围神经毒性(62%).结论 卡培他滨联合多西紫杉醇和奥沙利铂方案治疗晚期转移性食管癌疗效确切、毒副反应可耐受.     

周剂量多西紫杉醇联合卡培他滨治疗晚期胃癌的临床观察

目的观察周剂量多西他赛联合卡培他滨治疗晚期胃癌的近期疗效和不良反应。方法 37例晚期胃癌患者采用多西他赛35mg/m2,静脉滴注,第1,8天;卡培他滨1250mg/m2,bid,口服,1～14d,21d为1周期。3周期后评价疗效和不良反应。结果全组37例患者均可评价疗效,其中CR3例（8.1%）,PR19例（51.3%）,SD10例（27.0%）,PD5例（13.5%）,总有效率59.5%。中性粒细胞减少发生率54.0%。中位TTP为6.5个月（3.2～11.5个月）,中位MST为10.3个月（5.8～14.7个月）。结论多西他赛联合卡培他滨治疗晚期胃癌有效率较高,血液学毒性低,近期疗效较好,用药方便、安全,明显提高了患者的生活质量。     

奥沙利铂联合卡培他滨治疗体力状况削弱的晚期胃癌临床观察

为了评估奥沙利铂联合卡培他滨治疗体力状况削弱的(KPS≤70)晚期胃癌的毒性和疗效,应用奥沙利铂联合卡培他滨治疗21例晚期胃癌患者。奥沙利铂100mg/m2,静脉滴入,持续3h,d1;卡培他滨1650mg/(m2·d),分2次口服,d1~d14;21d为1个周期。患者每2个周期行CT检查以评估疗效,并监控其毒性。结果:所有患者均可评估毒性,21例中有20例可评估疗效。PR6例(30%),SD8例(40%),PD6例(30%),有效率为30·0%。中位进展时间4·5个月,中位生存时间8·3个月。初步研究结果提示:奥沙利铂联合卡培他滨治疗体力状况削弱(KPS≤70)的晚期胃癌有效,且有良好的耐受性。     

奥沙利铂联合卡培他滨治疗进展期胃癌的临床观察

目的 观察奥沙利铂(L-OHP)联合卡培他滨治疗晚期胃癌的有效性和安全性.方法 晚期胃癌29例采用奥沙利铂130 mg/m2,静脉滴注4 h,d1;卡培他滨1 000 mg/m2,口服,2次/d,d1～14.21 d为1个周期,连用2个周期后评价疗效.结果 29例中,完全缓解(CR)1例,占3.4%;部分缓解(PR)13例,占44.8%;稳定(SD)10例,占34.5%;进展(PD)5例,占17.2%.总有效率(CR+PR)为48.3%.毒副反应主要为骨髓抑制、消化道反应和手足综合征等.结论 奥沙利铂联合卡培他滨治疗晚期胃癌疗效较好,安全性高.     

周剂量多西他赛联合顺铂与周剂量多西他赛联合奥沙利铂治疗晚期胃癌的临床研究

背景与目的:已有研究证实,多西他赛联合顺铂(docetaxel plus cisplatin,DP)或多西他赛联合奥沙利铂(docetaxel plus oxaliplatin,DO)治疗晚期胃癌具有较好的疗效。本研究旨在观察周剂量多西他赛联合顺铂与周剂量多西他赛联合奥沙利铂一线治疗晚期胃癌的疗效及不良反应。方法:76例胃癌患者随机分为两组,每组38例,DP组多西他赛35 mg/m2,静脉滴注,第1、8天,顺铂60 mg/m2,静脉滴注,第1天,21 d为1个周期;DO组多西他赛35 mg/m2,静脉滴注,第1、8天,奥沙利铂120 mg/m2,静脉滴注,第1天,21 d为1个周期。结果:DP组总有效率为37%,中位无进展生存期为4.9个月,中位生存期为9.7个月;DO组总有效率为41%,中位无进展生存期为4.4个月,中位生存期为12.3个月。两组的总有效率(P=0.707)、中位无进展生存期(P=0.324)、中位生存期(P=0.581)差异均无统计学意义。两组的3/4级不良反应都是中性粒细胞减少,DP组恶心、呕吐发生率较高(P<0.05),而DO组周围神经病变发生率较高(P<0.05);两组贫血、血小板减少、脱发、腹泻和肝功能损害等不良反应差异均无统计学意义(P>0.05)。结论:DP和DO一线治疗晚期胃癌的疗效及不良反应相仿,值得临床进一步研究。     

卡培他滨联合奥沙利铂治疗老年晚期胃癌32例分析

[目的]评价卡培他滨联合奥沙利铂治疗老年晚期胃癌的临床疗效和毒副反应。[方法]32例老年胃癌患者,予以卡培他滨2000mg/m2,d1~14口服,奥沙利铂100mg/m2,d1,每21d为1个周期,完成2个周期后评价疗效,并观察毒副反应。[结果]28例可评价,总有效率42.9%,中位疾病进展时间6.1个月,1年生存率43.4%。毒副反应以粒细胞减少、乏力、贫血为主,Ⅲ~Ⅳ度毒副反应少见。[结论]卡培他滨联合奥沙利铂治疗老年晚期胃癌显示了较好的疗效,患者耐受性较好。     

周剂量多西他赛联合卡培他滨治疗晚期胃癌的临床观察

为了观察周剂量多西他赛(DOC)联合卡培他滨(CAP)方案治疗晚期胃癌的临床疗效及毒副反应,对36例晚期胃癌患者,采用DOC 35mg/m2,静脉滴入,d1、d8;CAP 2000mg/m2,口服,2次/d,d1～d14,21d为1个周期,至少2个周期后评价疗效.全组36例均可评价疗效,其中完全缓解2例,部分缓解16例,稳定11例,疾病进展7例,总有效率为50.0%,中位疾病进展时间5.3个月,中位生存期11.6个月.毒副反应主要是骨髓抑制、胃肠道反应及口腔炎,均为可逆性.初步研究结果提示,周剂量多西他赛联合卡培他滨治疗晚期胃癌疗效确切及毒副反应轻,患者耐受性好,值得临床推广.     

拓扑替康联合环磷酰胺治疗儿童神经母细胞瘤

目的观察评价拓扑替康联合环磷酰胺治疗神经母细胞瘤的疗效和毒性.方法14例神经母细胞瘤患儿,应用拓扑替康联合环磷酰胺联合静脉用药.大剂量应用环磷酰胺[70mg/(kg·d)×2 d]和拓扑替康[2mg/(m2·d)×3 d].其中12例治疗2～13个周期,进行疗效和不良反应评价.结果12例患者中,进展3例,稳定及缓解9例,总有效率为75%.不良反应主要为骨髓抑制和消化道反应,但对症治疗后,无相关性死亡.结论拓扑替康联合环磷酰胺治疗儿童神经母细胞瘤安全有效.     

宫颈癌患者中联合检测血清VEGF及SccAg的意义

目的：寻找较为敏感的肿瘤标志物指导制定正确的治疗方案及预测预后。方法：1999年7月至2001年1月，本院妇科住院治疗的宫颈鳞癌37例，用ELISA法测定血清中VEGF值，MEIA法测定血清中SccAg值。用X^2检验，t检验，方差分析及多元线性回归分析行统计处理。以子宫肌瘤26例作为对照。结果：宫颈癌治疗前血清VEGF明显高于良性的子宫平滑肌瘤血清值（P＜0．01）；深肌层浸润及晚期未术病例其血清VEGF及SccAg值均较浅肌层浸润者高（P＜0．01）；宫颈癌Ⅰ－Ⅱ期血清VEGF值明显低于Ⅲ－Ⅳ期者（P＜0．01），术中无残留者明显低于术中有残留者（P＜0．01），淋巴结无转移者明显低于有转移者（P＜0．01），治疗后无复发者（半年内）明显低于有复发者（P＜0．01）。对于血清SccAg而言，其在宫颈癌中表达的阳性率为67．56％。临床I－II期血清SccAg值明显低于Ⅲ－Ⅳ期者（P＜0．01），淋巴结无转移者明显低于有转移者（P＜0．01）。而治疗后有无复发、术中有无残留对其的影响不显著（P＞0．05）。结论：VEGF与SccAg可作为宫颈癌预后判断及宫颈癌术后是否要补充外照射的参考指标。     

Risk of Treatment-related Mortality with Sorafenib in Patients with Cancer

Background: Fatal adverse events (FAEs) have been reported with sorafenib, a vascular endothelial growthfactor receptor kinase inhibitor (VEGFR TKI). We here performed an up-to-date and detailed meta-analysis todetermine the overall risk of FAEs associated with sorafenib. Methods: Databases, including PubMed, Embaseand Web of Science, and abstracts presented at the American Society of Clinical Oncology annual meetingswere searched to identify relevant studies. Eligible studies included randomized controlled trials evaluatingsorafenib effects in patients with all malignancies. Summary incidence rates, relative risks (RRs), and 95%confidence intervals (CIs) were calculated for FAEs. In addition, subgroup analyses were performed accordingto tumor type and therapy regimen. Results: 13 trials recruiting 5,546 patients were included in our analysis.The overall incidence of FAEs with sorafenib was 1.99% (95%CI, 0.98-4.02%). Patients treated with sorafenibhad a significantly increased risk of FAEs compared with patients treated with control medication, with an RR of1.77 (95%CI 1.25-2.52, P=0.001). Risk varied with tumour type, but appeared independent of therapy regimen.A significantly increased risk of FAEs was observed in patients with lung cancer (RR 2.26; 95% CI 1.03-4.99;P= 0.043) and renal cancer (RR 1.84; 95% CI 1.15-2.94; P= 0.011). The most common causes of FAEs werehemorrhage (8.6%) and thrombus or embolism (4.9%). Conclusions: It is important for health care practitionersto be aware of the risks of FAEs associated with sorafenib, especially in patients with renal and lung cancer.     

美罗华联合化疗治疗B细胞非霍奇金淋巴瘤25例

目的本研究旨在观察美罗华联合化疗治疗B细胞非霍奇金淋巴瘤的疗效和毒副反应。方法我科从2003年8月至2007年2月共有25例经病理确诊的CD20阳性B细胞型非霍奇金淋巴瘤患者接受美罗华联合化疗，中位疗程数为4（2～6）。化疗方案包括CHOP、ProMACE／cytaBOM、FMD、FC、COP、COPP、DVAE。结果25例中完全缓解（CR）16例（64．0％）；部分缓解（PR）8例（32．0％）；总有效（OR）率为96．0％。治疗后随访期3～44个月，中位缓解期32个月，4例存活3个月以上，1例因肿瘤晚期进展死亡，其余20例存活8个月以上（80％），最长已存活45个月。主要毒副反应为骨髓抑制，22例出现白细胞减少，其中Ⅲ～Ⅳ度6例；其它毒副反应包括Ⅰ～Ⅱ度恶心呕吐、轻度脱发和肝功能受损等。美罗华输注相关毒副反应主要有Ⅰ～Ⅱ度寒战和发热、皮疹、诱发哮喘、间质性肺炎、低免疫球蛋白血症等，经对症治疗后均得到缓解。结论美罗华联合化疗治疗B细胞非霍奇金淋巴瘤具有良好的临床疗效且毒副反应较小。     

Adjuvant chemotherapy with anthracyclines in comparison with the standard combination of CMF in breast cancer with high risk of relapse

The effectiveness of adjuvant therapy with adriablastin and doxorubicin for breast cancer has been compared to that of standard CMF. During 1985-1990, the study included 349 patients with T1-2N2M0 and T3N0-2M0 tumors; mean age--46 yrs; mean follow-up--96.7 months. Overall survival rate in the doxorubicin group was 73%, CMF--62%; relapse-free survival--62.1 and 55%, respectively. The absolute difference in overall survival rates (11%) proved barely significant (p = 0.056). However, the difference in overall survival (p < 0.05) after anthracyclines and CMF in patients with tumors T1-2N2M0 and T3N1M0 was significant and in favor of the former. As far as frequency and degree of side-effects is concerned, their patterns were practically identical in both groups, except for the significantly higher frequency of cardiotoxity and complete alopecia in doxorubicin therapy. Cardiotoxic complication rate was significantly reduced from 13.8 to 3.9% by cardioxane treatment.     

Phase I Study of Topotecan in Combination with Concurrent Radiotherapy in Adults with Glioblastoma

A phase I study was performed to determine the maximum tolerated dose and the recommended dose of continuous intravenous infusion of topotecan in combination with radiotherapy (RT) in patients with previously untreated glioblastoma multiforme (GBM). Twenty patients with histologically proven GBM and 1 with rhabdoid tumor were enrolled. After surgery or stereotactic biopsy, patients received cranial RT (60 Gy/30 fractions/40 days) and 3 cycles of topotecan as continuous infusion (CIV) from day 1 to 5 on weeks 1, 3, and 5 during RT. The dose of topotecan was escalated from 0.6 to 1.0 mg/m2/day. Four dose levels were tested. One grade 4 thrombocytopenia was seen at level 1 (topotecan dose 0.6 mg/m2/day; 6 patients). No dose-limiting toxicity was seen at level 2 (0.8 mg/m2/day; 3 patients) or an intermediate level of 2 bis (0.9 mg/m2/day; 6 patients). Six patients were included at level 3 (1.0 mg/m2/day), 4 of whom experienced dose-limiting toxicities, including 3 episodes of grade 4 thrombocytopenia, 1 platelet transfusion, 1 febrile neutropenia, and 1 grade 4 neutropenia of more than 7 days. Eighty percent of patients with GBM were alive at 12 months. The dose-limiting toxicity of topotecan administered as CIV for 5 days every 2 weeks is hematological. The maximum tolerated dose is 1.0 mg/m2/day and the recommended dose is 0.9 mg/m2/day. A phase II trial using the recommended dose of topotecan is ongoing.     

Analysis of dermatologic events in patients with cancer treated with lapatinib

Purpose Dermatologic events (DEs) in patients with cancer treated with lapatinib, a small-molecule dual tyrosine kinase inhibitor (TKI) of epidermal growth factor receptor (EGFR [ErbB1]) and HER2 (ErbB2), were characterized. Patients and methods Nine clinical trials of metastatic cancer were included in this analysis. Lapatinib was administered at doses ranging from 1000 to 1500 mg/day as monotherapy (n = 928) or in combination with paclitaxel or capecitabine (n = 491). Patients not treated with lapatinib comprised the control group. Dermatologic events included hand-foot syndrome, rash, hair disorder, dry skin, pruritus/urticaria, skin disorder, skin infection, and nail disorder; DEs were characterized based on type, time to onset, severity, duration, and required interventions. Results Fifty-eight percent of patients treated with lapatinib monotherapy, 74% treated with lapatinib plus paclitaxel or capecitabine, and 53% in the control group developed DEs. Among patients receiving lapatinib monotherapy, 55% experienced grade 1/2 DEs, 3% had grade 3 DEs, and no grade 4 DEs were observed. The most common DE was rash (43%); all other events occurred in ≤8% of patients. Most DEs developed between days 1 and 14 of starting treatment, with a median duration of 29 days. Three percent of DEs led to lapatinib dose reduction, 7% resulted in dose interruption, and 1% led to drug discontinuation. Conclusions Most DEs in lapatinib-treated patients present early, are mild to moderate in severity, and infrequently require dose modification or treatment interruption. Lapatinib-associated DEs appear to differ clinically from those associated with EGFR TKIs in both frequency and severity.     

Prophylaxis of Pneumocystis carinii pneumonia with atovaquone in children with leukemia

BACKGROUND: Despite extensive studies of atovaquone in human immunodeficiency virus (HIV)-infected patients, there is little information about its efficacy as a prophylactic agent for Pneumocystis carinii pneumonia (PCP) in pediatric patients with cancer. Therefore, a retrospective analysis was conducted to determine the incidence of PCP in pediatric patients who received prophylactic atovaquone during treatment for acute leukemia. METHODS: We reviewed the medical records of all patients treated at our institution for acute lymphoblastic leukemia or acute myeloid leukemia between 1994 and 2004. Only patients who were intolerant of trimethoprim-sulfamethoxazole (TMP-SMZ) and received atovaquone prophylaxis were included in the analysis. RESULTS: Eighty-six patients were unable to tolerate TMP-SMZ and received daily atovaquone for PCP prophylaxis. PCP was not diagnosed in any patient who received atovaquone prophylaxis: the upper limit of the 95% confidence interval (CI) was 1.74 per 100 person-years. CONCLUSIONS: Atovaquone is an efficacious alternative for PCP prophylaxis in pediatric patients who have leukemia and are intolerant of TMP-SMZ.     

Temozolomide in combination with fotemustine in patients with metastatic melanoma

Purpose  Temozolomide and fotemustine are both active drugs for treating metastatic melanoma. The present study was designed to assess the efficacy and safety of combination therapy with temozolomide + fotemustine in patients with metastatic melanoma. Methods  Forty patients (median age 50.5 and 22 males) with pathologically confirmed, unresectable, AJCO stage IV melanoma were enrolled into the study. The primary endpoints were tumor response and safety. Patients received oral temozolomide 125 mg/m² on days 1–7 and intravenous fotemustine 80 mg/m² on day 3 every 3 weeks. Results  Fourteen (35%) patients achieved an objective response, including 3 (7.5%) complete and 11 (27.5%) partial responses. Median overall survival time was 6.7 months and 6-month survival rate was 57.4%. Myelosupression, particularly thrombocytopenia, was the primary toxicity. Conclusion  The regimen, temozolomide combined with fotemustine, is an active and moderately safe first-line chemotherapy regimen with acceptable and easily manageable toxicities in patients with metastatic melanoma.     

经翼点入路显微手术切除小儿颅咽管瘤20例

目的　探讨提高手术根治颅咽管瘤的方法。方法　对 2 0例颅咽管瘤 ,均在全麻下行翼点入路 ,采用显微外科技术 ,根据肿瘤的位置 ,采用视交叉前间隙、颈内动脉和视神经间隙及颈内动脉外侧等间隙切除肿瘤。结果　全切除 16例、近全切除 3例、大部切除 1例。近期明显好转 14例、改善 4例、无变化及死亡各 1例。半年以上随访 18例 ,能正常生活者 16例 ,生活需人照顾 2例。结论　翼点入路手术能满足鞍区多种类型颅咽管瘤的显露 ,能提高肿瘤全切率及治愈率。