行气消坚方联合艾迪注射液治疗中晚期原发性肝癌32例

[目的]评价中药行气消坚方联合艾迪注射液治疗中晚期原发性肝癌的临床疗效。[方法]62例中晚期原发性肝癌患者随机分为两组,治疗组（32例）采用艾迪注射液静滴联合中药行气消坚方口服治疗;对照组（30例）单纯采用艾迪注射液静滴治疗,28d为1个周期,2个周期后评定临床疗效。[结果]治疗组临床症状改善Karnofsky体力状况评分提高,且优于对照组（P〈0.05）;治疗组和对照组有效率（CR＋PR）分别为6.25%和3.33%,疾病控制率（CR＋PR＋SD）分别为75.00%、70.00%,差异均无统计学意义。[结论]中药行气消坚方联合艾迪注射液治疗中晚期原发性肝癌能减轻患者的临床症状,可以改善患者生活质量。     

艾迪注射液联合GP方案治疗晚期非小细胞肺癌68例

[目的]分析艾迪注射液联合化疗治疗晚期非小细胞肺癌（NSCLC）的疗效、毒性及对免疫功能的影响。[方法]130例晚期NSCLC患者随机分为治疗组和对照组，分别接受GP方案（吉西他宾、顺铂）加艾迪注射液或单纯GP方案化疗。[结果]治疗组部分缓解率44．1％，对照组40.3％（P〉0．05），中位缓解期分别为5．8个月和5～3个月。化疗后治疗组T淋巴细胞及T辅助细胞（T4）水平明显高于对照组。治疗组毒性反应与对照组基本相同。治疗组生活质量明显改善。[结论]对晚期非小细胞肺癌的治疗，仍应采取以全身化疗为主的联合方案，艾迪注射液通过调节患者免疫功能，提高患者生活质量。     

复方苦参注射液联合吉西他滨治疗老年晚期非小细胞肺癌64例

[目的]观察复方苦参注射液联合吉西他滨治疗老年晚期非小细胞肺癌的疗效及耐受性。[方法]将126例60岁以上非小细胞肺癌患者随机分成两组：对照组62例，仅予以常规化疗；治疗组64例，在常规化疗的基础上加用复方苦参注射液。[结果]治疗组总有效率（CR＋PR）为37．5％，对照组总有效率为22．6％，两组之间差异有显著性（p〈0．05）。治疗组KPS评分改善率为40．6％，明显高于对照组的25．8％（P〈0．05）。两组间化疗毒副反应差异无统计学意义（P〉0．051。[结论]复方苦参注射液联合吉西他滨对老年晚期非小细胞肺癌患者治疗有效，且耐受性好。     

艾迪注射液联合小剂量化疗治疗肝癌的疗效观察

目的观察艾迪注射液联合小剂量化疗治疗肝癌的疗效。方法42例原发性晚期肝癌患者随机分为治疗组和对照组，治疗组24例，对照组18例。治疗组顺铂（DDP）10mg，静滴d1-5，d8-12，5-氟脲嘧啶（5-Fu）250mg静滴d1-5，d8-12。化疗期间合并艾迪注射液60-100mg静滴d1-15，。对照组单纯化疗。21d为1周期。结果观察两组患者的疗效、生活质量、骨髓功能的变化。治疗组在生活质量、保护化疗后骨髓功能方面明显优于对照组，KPS评分，治疗组上升66．7％（16／24），对照组上升27．8％（5／18），差异具有统计学意义（P〈0．05）。主要不良反应为骨髓抑制、胃肠道反应和静脉炎，治疗组明显低于对照组，两组比较具有统计学意义（P〈0．05），静脉炎的发生率较高，两组比较无统计学意义。肿瘤疗效治疗组37％，对照组33％，两组比较差异无统计学意义。结论艾迪联合小剂量化疗治疗晚期原发性肝癌，患者可耐受，临床受益率高。     

复方苦参注射液和艾迪注射液改善晚期肺癌患者生存质量的随机对照研究

 目的 探讨复方苦参注射液和艾迪注射液在改善晚期肺癌患者生存质量方面的作用。方法 60例经病理确诊的晚期肺癌患者按信封法随机分为2组,苦参组30例采用复方苦参注射液加基础治疗,艾迪组30例采用艾迪注射液加基础治疗,静脉滴注2个周期后评价疗效。监测两组近期疗效、临床疗效、Karnofsky评分及肿瘤标志物CA125、CEA的变化。结果 治疗后比较客观疗效,苦参组稳定率为83.3 %（25／30）,艾迪组稳定率为80.0%（24／30）,两者比较差异无统计学意义（P＞0.05）;苦参组临床疗效改善率为83.3 %（25／30）,艾迪组改善率为80.0 %（24／30）,两者比较差异无统计学意义（P＞0.05）;Karnofsky评分比较,两组增加稳定率均为90.0 %（27／30）。艾迪组在改善神疲乏力、气短懒言、烦渴欲饮、腰膝酸软等气虚症状上优于苦参组（均P＜0.05）,苦参组在改善大便干结、五心烦热、午后颧红等阴虚内热症状上优于艾迪组（均P＜0.05）。两组的肿瘤标志物CA125和CEA治疗前后下降发生率比较差异无统计学意义（P＞0.05） 。苦参组治疗前肝功能异常的3例,治疗后均恢复正常,艾迪组治疗前2例肝功能异常者,治疗后1例恢复正常。结论 复方苦参注射液和艾迪注射液治疗晚期肺癌均具有较好的治疗效果,疗效相当。但在改善中医相关症状上两者显示了各自特点。复方苦参注射液能较好改善热毒的症状;艾迪注射液能较好改善气虚的症状。复方苦参注射液对于肺癌合并肝功能异常或伴有疼痛者更为有效。     

健脾益气中药联合化疗治疗晚期大肠癌47例

[目的]比较健脾益气中药联合化疗与单纯化疗治疗晚期大肠癌的临床疗效。[方法]47例晚期大肠癌患者随机分为治疗组（中药加化疗）和对照组（单纯化疗）,观察临床疗效、生活质量、毒副反应及生存期。[结果]治疗组生活质量改善和毒副反应情况明显优于对照组（P〈0．05）;两组临床疗效及1、2、3年生存率和中位生存期比较差异无统计学意义（P〉0．05）。[结论]健脾益气中药联合化疗可改善晚期大肠癌患者的生活质量、减少化疗药物的毒副反应。     

艾迪注射液改善年老体弱晚期癌症患者生活质量的临床观察

目的观察艾迪注射液治疗年老体弱的晚期癌症患者的近期疗效、疼痛缓解情况、生活质量及生存期的影响。方法将143例老年晚期癌症患者随机数字表法随机分为治疗组和对照组，其中对照组71例，给予对症、支持等常规治疗；治疗组72例，在对照组用药基础上给予艾迪注射液50～60ml加入0．9％氯化钠溶液250ml静脉滴注，1次／d，21d为1个疗程，2个疗程结束后评价两组的近期疗效、疼痛缓解情况、生活质量变化及生存期。结果治疗组有效【完全缓解（CR）＋部分缓解（PR）]率仅为2．8％（2／72），对照组无缓解病例；而临床受益[CR＋PR＋无变化（sD）1率为66．7％（48／72），明显高于对照组31．0％（22／71），差异有统计学意义（P〈0．05）。治疗组疼痛缓解总有效率为67．6％（25／37）；明显高于对照组36．1％（13／36）（P〈0．05）。治疗组中位生存期为6．2个月，高于对照组5．1个月（P〉0．05）。治疗组治疗前、后生活质量良好率分别为18．1％（13／72）和66．7％（48／72），对照组分别为15．5％（11／71）和22．5％（16／71）（P〈0．05）。治疗组不良反应极小。结论艾迪注射液治疗年老体弱的晚期癌症患者有一定抑制肿瘤生长的作用，能缓解癌痛并提高晚期癌症患者的生活质量，安全，值得临床推广应用。     

复方苦参注射液配合射频治疗晚期食管癌的临床观察

目的 评价中药复方苦参注射液在射频治疗晚期食管癌中的抗癌增效作用。方法 87例晚期食管癌被随机分为：复方苦参注射液＋射频治疗组（治疗组）和单纯射频治疗组（对照组）。两组射频治疗方法相同，均为常规治疗。治疗组在射频治疗开始即用复方苦参注射液静滴，连续使用3～4个疗程方可评价。结果 治疗组的有效率为44．14％，而对照组有效率为22．22％，两者差异有统计学意义（χ^2=4．086，P〈0．05）；KPS改善均有统计学意义（P=0．037）。结论 中药复方苦参注射液配合射频治疗晚期食管癌可提高近期疗效和生活质量，且无明显的毒副作用，但远期疗效尚需进一步观察。     

艾迪注射液加NP方案治疗中晚期非小细胞肺癌临床疗效观察

目的观察艾迪注射液配合NP方案治疗非小细胞肺癌（NSCLC）的疗效。方法98例NSCLC随机分为两组，治疗组接受艾迪加NP方案，对照组单用NP方案。两组均以4周为1个周期，重复3个周期。结果治疗组比对照组的近期客观疗效有效率高，但差异无显著性（P〉0．05）；而临床症状及生存质量改善率差异有显著性（P〈0．05）。结论艾迪注射液有助于NSCLC患者临床症状的改善并提高生存质量。     

康莱特注射液配合胃肠外营养治疗癌症恶液质

[目的]探讨康莱特注射液配合胃肠外营养治疗癌症晚期恶液质的疗效及毒副作用。[方法]晚期癌症恶液质患者61例，分对照组30例单用胃肠外营养，治疗组31例用康莱特注射液配合胃肠外营养。[结果]治疗组卡氏评分提高大于10分的占74．2％，对照组提高10分的占30％，两组比较差异有显著性，P〈0．05；治疗组体重增加的占54．8％，对照组占40％，两组比较，P〉0．05：治疗组癌症疼痛缓解率为74．2％，对照组为23.3％，两组比较，P〈0．05。[结论]康莱特注射液能够改善癌症晚期患者恶液质的精神状况，增加食欲及体重，缓解癌痛，提高抗体的免疫功能．     

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.