紫杉醇脂质体加奈达铂联合放疗治疗老年食管癌的临床观察

目的 观察紫杉醇脂质体加奈达铂诱导化疗后三维适形放疗治疗老年食管癌的疗效及毒副反应.方法 60例老年食管癌患者随机分为2组.放化组30例:先予紫杉醇脂质体加奈达铂化疗,化疗1周后开始三维适形放疗;单放组30例:单纯采用三维适形放疗.结果 放化组、单放组近期有效率分别为93.3％和83.3％,差异无统计学意义(P＞0.05).2组的毒副反应以Ⅰ～Ⅱ 度为主,放化组骨髓抑制发生率高于单放组(P＜0.05).结论 紫杉醇脂质体加奈达铂化疗联合放疗治疗老年食管癌近期疗效确切,毒副反应可耐受.     

紫杉醇联合奈达铂化疗同步适形调强放疗治疗局部晚期食管癌的疗效

目的：探讨紫杉醇联合奈达铂化疗同步适形调强放疗治疗局部晚期食管癌的疗效。方法选取局部晚期食管癌患者60例,分为2组,对照组30例仅给予单纯调强放疗,观察组30例给予紫杉醇联合奈达铂化疗同步适形调强放疗,比较观察2组的疗效和安全性。结果观察组总有效率为96.7％,明显高于对照组的80.0％,差异有统计学意义（P ﹤0.05）。观察组毒副反应以恶心呕吐和Ⅰ、Ⅱ度骨髓抑制为主,对照组以放射性肺炎、放射性食管炎为主。结论局部晚期食管癌采用紫杉醇联合奈达铂化疗同步适形调强放疗治疗,疗效好,安全性高。     

局部晚期胰腺癌替吉奥联合三维适形放疗的临床观察

目的:观察替吉奥联合三维适形放射治疗局部晚期胰腺癌的近期疗效和毒副反应。方法:48例局部晚期胰腺癌患者随机分为2组,单纯局部三维适形放疗组(对照组)24例,替吉奥联合三维适形放疗组(联合组)24例。两组均采用三维适形放疗技术,每周5次,3.0Gy/次,共18次,联合组在放疗第1天开始口服替吉奥胶囊〔80mg/(m2.d),2次/d,d1～d14,21d为1个周期〕,共2个周期。结果:对照组和联合组放疗结束时总有效率分别为45.8%和79.1%,P<0.05。骨髓抑制发生率分别为41.6%和75.0%,P<0.05;消化道反应发生率分别为58.3%和66.7%,P>0.05,经对症处理后均可缓解。结论:替吉奥联合三维适形放疗疗效优于单纯放疗,毒副反应可耐受。     

晚期食管鳞癌放疗联合口服替吉奥治疗的疗效

目的:评估口服替吉奥联合三维适形放疗治疗局部晚期食管癌的疗效和安全性.方法:48例局部晚期食管癌患者进入研究,随机分为单纯放疗组(24例)和放疗联合替吉奥化疗组(24例).比较两组患者的疗效、生存时间和不良反应.结果:单纯放疗组客观缓解率62.50%,放化疗联合组客观缓解率91.67%,有显著统计学差异(P<0.05).两组不良反应、生活质量无显著差异.单纯放疗组3年生存率32.33%,放化疗联合组3年生存率61.34%,有显著统计学差异(P<0.05).结论:三维适形放疗同步口服替吉奥化疗治疗晚期食管鳞癌可以有效提高患者的治疗效果,改善预后,不良反应可以耐受,是一种安全有效的治疗方案.     

替吉奥胶囊联合三维适形放疗治疗中晚期食管癌的临床观察

观察替吉奥胶囊联合三维适形放疗治疗中晚期食管癌的近期疗效和毒副反应。58例中晚期食管癌患者随机分成两组,替吉奥胶囊联合三维适形放疗(联合治疗组)32例,单纯放疗组26例,三维适形放疗分割剂量为1.8Gy/次,5次/周,总量50.4Gy/28次,联合治疗组:替吉奥胶囊自放疗第1天开始,按体表面积<1.2m2,40mg,2次/d,1.2～1.5m2,50mg,2次/d,>1.5m2,60mg,2次/d,与放疗同步,服4周,休2周,直至放疗结束。结果联合治疗组CR 5例,PR 19例,总有效率75.0%,单纯放疗组CR 2例,PR 10例,总有效率为46.2%,两组相比有统计学意义,P=0.007。在毒副反应方面,两组总体耐受良好,无严重不良事件发生。初步研究结果提示,替吉奥胶囊联合三维适形放疗治疗中晚期食管癌是一种安全有效的治疗方法。     

S-1同步低剂量三维适形放疗治疗局部晚期食管癌的临床观察

目的 观察替吉奥(S-1)同步低剂量三维适形放疗治疗局部晚期食管癌的近期疗效及毒副反应.方法 60例局部晚期食管癌患者随机分为试验组和对照组,试验组32例接受S-1同步低剂量三维适形放疗,而对照组28例仅接受单纯三维适形放疗.结果 试验组、对照组有效率分别为 84.4%、78.6%,比较差异无统计学意义(P>0.05); 试验组、对照组放射性食管炎发生率分别为43.8%、64.3%,放射性肺炎发生率分别为15.6 %、39.3 %,比较差异均有统计学意义(P均<0.05).结论 S-1同步低剂量三维适形放疗治疗局部晚期食管癌是一种安全有效的方法.     

替吉奥联合放疗治疗局部晚期食管癌疗效分析

目的 比较替吉奥联合三维适形放疗治疗老年人局部晚期食管癌与单纯放疗、单药替吉奥化疗的疗效.方法 选择同期治疗的老年局部晚期食管癌患者62例,分为放疗联合替吉奥组26例、单纯放疗组20例和单药替吉奥化疗组16例,放疗联合替吉奥组在三维适形放疗第1天开始口服替吉奥胶囊,每次40 mg/m2,2次/d,连服14 d,休息7d,21 d为1个周期,与放疗同步进行共2个周期;单纯放疗组仅行三维适形放疗;单药替吉奥化疗组每次口服替吉奥胶囊40 mg/m2,每日2次,连服28 d,休息14 d.结果 放疗联合替吉奥组近期疗效完全缓解（CR）13例,部分缓解（PR）11例,稳定（SD）1例,总有效率为92.31％;单纯放疗组CR 4例,PR 8例,SD 6例,总有效率为60.00％;单药替吉奥化疗组CR 1例,PR 4例,SD 6例,总有效率为31.25％.前组疗效高于后两组（P＜0.05）.三组1、2、3年远期生存率分别为76.92％、57.69％、42.31％,75.00％、55.00％、40.00％和68.75％、50.00％、25.00％,差异无统计学意义（P＞0.05）.不良反应中血液学毒性放疗联合替吉奥组稍高于单纯放疗组及单药替吉奥化疗组,放射性食管炎、放射性肺炎发生率放疗联合替吉奥组和单纯放疗组间差异无统计学意义（P＞0.05）.结论 替吉奥联合三维适形放疗治疗老年局部晚期食管癌疗效可靠,不良反应轻微,耐受性好.     

放疗同期联合奈达铂治疗中晚期食管癌临床观察

目的：观察放疗同期联合奈达铂化疗治疗中晚期食管癌的疗效及毒副反应。方法：57例中晚期食管癌患者随机分成实验组和对照组。对照组予三维适形放疗,2Gy/次,5次/周,总量60-66Gy。实验组与三维适形放疗同步行奈达铂化疗,30mg/m2静脉滴注,每周1次,共6次。治疗结束后3个月评价近期疗效和毒副反应。随访后评价远期疗效。结果：实验组有效率79.3%高于对照组53.6%（P〈0.05）。实验组1年生存率为78.2%,对照组为67.3%（P〈0.05）。实验组主要毒副反应为骨髓抑制,但均可耐受。结论：奈达铂单药联合三维适形放疗能明显改善中晚期食管癌患者疗效,虽不良反应增加但可以耐受。     

替吉奥胶囊口服同步三维适形放疗治疗老年食管癌近期疗效观察

目的:观察替吉奥联合三维适形放疗治疗老年食管癌的近期疗效及毒副反应。方法:76例老年食管癌患者随机分为研究组（38例）和对照组（38例）,研究组采用三维适形放疗联合替吉奥同步化疗,对照组单纯采用三维适形放疗,观察两组近期疗效及毒副反应。结果:研究组CR+PR 28例,有效率为 73.7％;对照组CR+PR 19例,有效率为 50.0％;两组有效率比较差异有统计学意义（P＜0.05）。研究组KPS评分升高及体重增加者分别为20例和25例,与对照组比较,有统计学差异（P＜0.05）。研究组治疗期间出现粒细胞下降22例,血小板减少10例,消化道反应12例,与对照组比较有统计学差异（P＜0.05）;同时,研究组治疗期间还出现贫血4例,放射性食管炎38例,放射性肺炎6例,与对照组比较差异无统计学意义（P＞0.05）。研究组和对照组均未见Ⅳ级毒副反应。结论:替吉奥联合三维适形放疗治疗老年食管癌近期疗效较好,且毒副反应可耐受。     

奈达铂同步放化疗治疗中晚期食管癌

目的 探讨奈达铂同步放化疗治疗中晚期食管癌的疗效和毒副反应.方法 59例中晚期食管癌患者随机分成两组:奈达铂周剂量化疗同步放疗组(A组)31例和单纯放疗组(B组)28例,两组放疗均采用常规分割,照射剂量60～66Gy.A组:奈达铂30mg/m2,每周1次,连续6周;B组:行单纯放疗.结果 A组CR 16例,PR 12例...     

Experience with Impedance Phlebography Compared with Venography

Venography is a particularly reliable method for the diagnosis of deep venous thrombosis but is not suitable as a screening test. Impedance phlebography represents another attempt to discover a simple, non-invasive and reliable method of detecting deep venous thrombosis. It does not, however, meet these criteria.     

Compliance with guidelines and correlation with outcome in patients with advanced germ-cell tumours

PurposeTo evaluate prior compliance with guidelines in patients treated with salvage chemotherapy for advanced germ-cell tumours (GCT).Patients and methodsData concerning the initial management of patients requiring salvage chemotherapy for GCT at Institut Gustave Roussy between 2000 and 2010 were obtained and correlated with recommendations for treatment. Criteria of non-compliance were defined based on guidelines. Compliance with guidelines, predictive factors for non-compliance and the impact on outcome were analysed.ResultsAmong 82 patients treated in the salvage setting, guidelines to initial treatment were followed in only 41 cases (50%). The most common non-compliance criteria were non-adherence to the planned dose (16%), an inappropriate interval between first-line chemotherapy cycles (16%), the lack of post-chemotherapy surgery (16%) and a long interval to post-chemotherapy surgery (48%). Compliance with standard care was better in cancer centres than in other hospitals (private or public) (Odd Ratio (OR): 6.9, P = 0.001). A poor-risk status according to the International Germ Cell Cancer Collaborative Group (IGCCCG) was also predictive of compliance in univariate but not in multivariate analysis. No significant difference in outcome after salvage chemotherapy was observed. Patients relapsing after non-compliant first-line therapy tended to be more easily salvaged, which is consistent with the fact that their initial treatment was inadequate. Some of these relapses were therefore probably not due to true biologically refractory disease.ConclusionGuidelines for first-line treatment are adhered to in only half the patients requiring salvage chemotherapy. As the only predictive factor for non-compliance was the treating centre, centralisation of patients with GCT in well-trained hospitals should be recommended.     

Treatment with methylnaltrexone is associated with increased survival in patients with advanced cancer

BackgroundMethylnaltrexone (MNTX), a peripherally acting μ-opioid receptor (MOR) antagonist, is FDA-approved for treatment of opioid-induced constipation (OIC). Preclinical data suggest that MOR activation can play a role in cancer progression and can be a target for anticancer therapy.Patients and methodsPooled data from advanced end-stage cancer patients with OIC, despite laxatives, treated in two randomized (phase III and IV), placebo-controlled trials with MNTX were analyzed for overall survival (OS) in an unplanned post hoc analysis. MNTX or placebo was given subcutaneously during the double-blinded phase, which was followed by the open-label phase, allowing MNTX treatment irrespective of initial randomization.ResultsIn two randomized, controlled trials, 229 cancer patients were randomized to MNTX (117, 51%) or placebo (112, 49%). Distribution of patients' characteristics and major tumor types did not significantly differ between arms. Treatment with MNTX compared with placebo [76 days, 95% confidence interval (CI) 43–109 versus 56 days, 95% CI 43–69; P = 0.033] and response (laxation) to treatment compared with no response (118 days, 95% CI 59–177 versus 55 days, 95% CI 40–70; P < 0.001) had a longer median OS, despite 56 (50%) of 112 patients ultimately crossing over from placebo to MNTX. Multivariable analysis demonstrated that response to therapy [hazard ratio (HR) 0.47, 95% CI 0.29–0.76; P = 0.002) and albumin ≥3.5 (HR 0.46, 95% CI 0.30–0.69; P < 0.001) were independent prognostic factors for increased OS. Of interest, there was no difference in OS between MNTX and placebo in 134 patients with advanced illness other than cancer treated in these randomized studies (P = 0.88).ConclusionThis unplanned post hoc analysis of two randomized trials demonstrates that treatment with MNTX and, even more so, response to MNTX are associated with increased OS, which supports the preclinical hypothesis that MOR can play a role in cancer progression. Targeting MOR with MNTX warrants further investigation in cancer therapy.Clinical trials numberNCT00401362, NCT00672477.     

Living with secondary breast cancer: coping with an uncertain future with unmet needs

JOHNSTON S.R.D. (2010) European Journal of Cancer Care 19 , 561–563 Living with secondary breast cancer: coping with an uncertain future with unmet needs     

奥沙利铂联合羟基喜树碱治疗晚期胃癌临床分析

背景与目的体外及体内的临床研究显示,奥沙利铂(L-OHP)对多种肿瘤有显著抑制作用并与绝大多数抗癌药物具有相加或协同细胞毒作用.本文旨在观察L-OHP联合羟基喜树碱(HCPT)治疗晚期胃癌的近期疗效和患者耐受性,并与传统的化疗方案进行对比.方法采用非随机的分组方法将43例晚期胃癌患者分为L-OHP+HCPT方案组(治疗组)与Vp-16+CF+5-FU(ELF)方案组(对照组),其中男性28例,女性15例,中位年龄59岁,KPS评分≥60,观察两组的近期疗效和患者耐受性.结果治疗组24例有效率58.3%(14/24),对照组19例有效率42.1%(8/19).治疗组有效率高于对照组,两组差异有显著性(P<0.05).两组不良反应主要是骨髓抑制、恶心、呕吐、口腔炎、周围神经炎、静脉炎、脱发等,均在Ⅰ、Ⅱ度范围内.结论L-OHP联合HCPT方案治疗晚期胃癌疗效较好,不良反应可以耐受.     

Varicella-Zoster Virus Prophylaxis with Low-Dose Acyclovir in Patients with Multiple Myeloma Treated with Bortezomib

BackgroundVaricella-zoster virus (VZV) reactivation is a common complication in patients with multiple myeloma (MM) treated with bortezomib, with an incidence rate of 10%-60%. The aim of our study was to analyze the effect of acyclovir prophylaxis in this patient population.Patients and MethodsWe studied 98 consecutive patients with relapsed MM treated with bortezomib. Bortezomib 1.3 mg/m² was given on days 1, 4, 8, and 11 of a 21-day cycle. At first, patients did not receive any VZV prophylaxis, but because of the high incidence of VZV reactivation, VZV prophylaxis with acyclovir was implemented subsequently.ResultsA total of 11 patients treated with bortezomib did not have any VZV prophylaxis, and 4 of these 11 patients (36%) developed VZV reactivation in the form of herpes zoster. No VZV reactivations were observed in the 32 patients who received acyclovir 400 mg 3 times daily or the 55 patients who received acyclovir in a dose reduced to 400 mg once daily during bortezomib treatment.ConclusionVaricellazoster virus reactivation is a common and serious adverse effect of bortezomib treatment. Acyclovir 400 mg once daily is sufficient to protect from VZV reactivation in patients with MM treated with bortezomib.     

Pseudomembranous colitis associated with chemotherapy with 5-fluorouracil

Pseudomembranous colitis is frequently associated with antibiotics and more rarely with chemotherapeutic agents such as 5-fluorouracil. The objective of this study is to show that it is possible to confuse this infection with chemotherapy associated toxicity. We present a 54 year old woman who underwent surgery for colorectal cancer and in the first cycle of chemotherapy with 5-fluorouracil developed pseudomembranous colitis. We detected the toxin B of Clostridium difficile in stools and we began early antibiotic treatment. Thus, in patients with post chemotherapy neutropenia and diarrhoea that develop negatively, we have to rule out this infection.