局部晚期食管癌新辅助治疗的研究进展

近年来,食管癌的治疗越来越倾向于多学科的综合治疗。多项研究已证明在手术的基础上加入放疗、化疗或免疫治疗可提高食管癌的生存获益。对于局部晚期食管癌患者,新辅助联合手术治疗效果明显,新辅助放化疗以及新辅助化疗均能够提高生存获益,但目前这两种治疗模式孰优孰劣尚存在争议。随着诱导化疗和新辅助免疫的加入,新辅助治疗模式更加多样化,进一步提高了病理完全缓解率,为局晚期食管癌患者的治疗提供了新思路。因此,本文旨在对近年来局晚期食管癌的新辅助治疗模式进行探讨,为进一步优化综合治疗策略提供参考。     

大肠癌新辅助化疗

新辅助化疗在大肠癌综合治疗中的作用已得到广泛共识,尤其对于进展期、复发和远处转移的大肠癌患者,在降低肿瘤分期,提高手术切除率方面已显示出越来越重要的地位。现综述近年来新辅助化疗在大肠癌中的研究进展。     

大肠癌新辅助化疗

新辅助化疗在大肠癌综合治疗中的作用已得到广泛共识,尤其对于进展期、复发和远处转移的大肠癌患者,在降低肿瘤分期,提高手术切除率方面已显示出越来越重要的地位。现综述近年来新辅助化疗在大肠癌中的研究进展。     

乳腺癌新辅助化疗再认识

近年来随着乳腺癌新辅助化疗研究的深入,该治疗手段已在临床被广泛应用。新辅助化疗使不可手术的局部晚期乳腺癌患者获得手术治疗的机会,并且提高具有较大肿瘤体积患者的保乳率,从而明显改善患者的生存质量,但仍有许多问题存在争议。本文将对乳腺癌新辅助化疗相关临床研究、以及对新辅助化疗的再认识进行综述。      

局部晚期鼻咽癌新辅助化疗研究进展

鼻咽癌的治疗手段是以放射治疗为主的综合治疗,随着调强放疗等精确放疗技术和放化综合治疗的广泛应用,初治鼻咽的局部控制率已经提高到90%以上。为了提高局部晚期鼻咽癌的治愈率、降低复发或远处转移,放疗与化疗的结合一直是学者们研究热点。由于同步放化疗已成为局部晚期鼻咽的标准治疗,新辅助化疗是鼻咽癌综合治疗研究的热点,新辅助联合同步放化疗是否获益一直存在争议。同时调强放疗的大量应用,同步化疗的地位受到怀疑,新辅助化疗在调强时代能否替代同步化疗及新辅助化疗后靶区应如何勾画值得进一步研究。因此,本文就新辅助化疗治疗局部晚期鼻咽癌的进展进行综述。     

化疗在胃癌综合治疗中的作用

化疗在胃癌综合治疗中占有重要地位。改善胃癌的预后，关键是提高早期诊断率。积极开展以手术治疗为主的综合治疗，特别是术后辅助化疗，同时，加强新辅功化疗的研宽。重点评速述疗对不能手术或术后复发转移的晚期胃癌治疗中的发展演变、新辅助(术前)化疗的前景与问题、辅助化疗的指征及其研究进展。     

剂量密集新辅助化疗治疗乳腺癌的研究进展

剂量密集辅助化疗能够改善早期高危乳腺癌患者的远期生存,同时缩短了治疗时间,是乳腺癌辅助化疗的重要选择.新辅助化疗是局部晚期乳腺癌的标准治疗方式,也是乳腺癌综合治疗的重要组成部分,近年来剂量密集化疗在新辅助化疗领域也进行了探索及研究.本文综述了剂量密集新辅助化疗治疗乳腺癌的文献报道,分析不同剂量密集新辅助化疗方案的疗效、...     

胃癌辅助治疗现状和进展

多学科综合治疗是局限期胃癌现代诊疗的模式,选择何种治疗方案应根据患者的特征而个体化选择。接受了标准D2术后胃癌患者,Ⅱ期患者可选择口服S-1或者XELOX联合化疗,而Ⅲb期及以上给与同步放化疗。单纯术前新辅助化疗可能不是一个理想的提高生存的策略,而围手术辅助化疗更为合理。目前尚无证据证明胃癌术前新辅助化疗/围手术化疗较单纯术后化疗有更好的生存,新辅助化疗的价值更多体现在降期和使不可R0切除的局部晚期肿瘤转化为可切除肿瘤。术前同步放化疗因降期和转化效率高而在不可切除局限期胃癌中更具探索价值。      

食管癌术前新辅助治疗原则及循证医学依据

在中国,手术虽是治疗食管癌的主要手段,但单纯手术治疗局部晚期食管癌的疗效不尽人意.近30年综合治疗的研究结果提示,术前新辅助治疗有望改善局部晚期食管癌患者的预后.本文就术前化疗和术前放化疗的国内外研究进展以及世界各国的应用经验作一综述,并就2011年中国抗癌协会食管癌专业委员会制定的<中国食管癌规范化诊治指南>作推荐指引.     

乳腺癌新辅助化疗的研究现状

<正>乳腺癌是妇女最常见的恶性肿瘤之一,部分患者初诊时已处于局部晚期,新辅助化疗应运而生,并且由于其独特优势,成为目前乳腺癌治疗中的热点。本文就新辅助化疗适应证、化疗方案选择、疗效预测等方面的问题及研究现状综述如下。     

Bevacizumab and oxaliplatin-based chemotherapy in metastatic colorectal cancer

In metastatic colorectal cancer disease progression correlates with serum VEGF levels. The importance of VEGF in tumor-induced angiogenesis is well described in preclinical models. In this review we discuss the role of anti-VEGF therapy in combination with oxaliplatin-based chemotherapy for the treatment of metastatic colorectal cancer. A recent Phase III clinical trial in patients with metastatic colorectal cancer demonstrated the efficacy of FOLFOX4 in combination with bevacizumab, a recombinant humanized monoclonal antibody with high binding specificity for VEGF, to improve median overall survival when used as second-line therapy. The major adverse events associated with bevacizumab include grade III hypertension, bleeding and the risk of gastrointestinal perforation. Combining bevacizumab with oxaliplatin-based chemotherapy as first-line treatment for patients with metastatic colorectal cancer improves progression-free survival, as seen in the NO16966 and Panitumumab Advanced Colorectal Cancer Evaluation (PACCE) studies, when compared with placebo and historical controls, respectively. Future research will need to focus on the mechanisms whereby bevacizumab enhances the benefit of chemotherapy to identify predictive markers that better define which patient populations will benefit the most from treatment.     

预测大肠癌化疗疗效的分子或基因指标

用于治疗大肠癌的药物主要有氟尿嘧啶、卡培他宾、依立替康、奥沙利铂、昔妥单抗、贝伐单抗,使大肠癌的化疗有效率明显提高,病人中位生存时间明显延长。但大肠癌化疗中原发和获得性耐药现象很普遍。一些分子或基因指标有可能预测大肠患者能否从辅助化疗或姑息化疗中获益。这篇综述主要回顾预测大肠癌化疗药物疗效的分子和基因指标,分析其联系,从而指导临床按个体化原则用药。     

结直肠癌术前化疗进展

结直肠癌在我国的发病率逐年递增,以手术为主导的综合治疗目前仍然是结直肠癌的主要治疗方法,综合治疗包括术前的放疗、化疗和放化疗联合等多种手段。本文仅对目前结直肠癌及肝转移的术前辅助化疗进展做一综述。     

结直肠癌辅助化疗的新观念和新进展

辅助化疗是结直肠癌综合治疗中的重要组成部分,也是防治远处转移的主要手段.近年来,结直肠癌辅助化疗涌现了许多新观念,取得了许多新进展.本文对此进行全面阐述,以指导临床上合理应用辅助化疗,提高结直肠癌的疗效,延长患者的生存期,改善生活质量.     

FOLFOX方案化疗对结直肠癌患者免疫细胞数的影响

背景与目的：化疗在杀伤肿瘤的同时,也损害了机体的正常免疫。很多文献曾报道晚期肠癌的化疗,常使细胞免疫功能抑制加重。本研究探讨FOLFOX方案即奥沙利铂联合亚叶酸钙及氟尿嘧啶联合化疗对结直肠癌患者免疫细胞数的影响及与健康人的差异。方法：80例结直肠癌患者行FOLFOX方案化疗（奥沙利铂85mg/m2,静脉滴注,第1天;亚叶酸钙200mg/m2,静脉滴注,第1天;氟尿嘧啶400mg/m2,第1天,2400mg/m2,持续静脉滴注46h）,2周1次,2次为1个疗程,采用流式细胞仪测定化疗前及化疗后2周、4周外周血T淋巴细胞亚群和NK细胞的活性,比较化疗前后的变化,同时根据临床分期进行亚组分析比较,以健康人作对照分析。结果：本组结直肠癌患者第1天、第2周及第4周外周血CD3＋、CD4＋、CD8＋、CD4＋/CD8＋及NK细胞活性比较均无显著下降（P〉0.05）,但患者外周血CD3＋、CD4＋、NK细胞数量及CD4＋/CD8＋比值与健康人相比下降,而CD8＋细胞比例显著升高,差异有显著性（P〈0.05）,提示免疫功能较健康人下降,而且外周血T淋巴细胞亚群和NK细胞数量的改变与结直肠癌临床病理分期有关,分期越晚,CD3＋、CD4＋及NK细胞数量CD4＋/CD8＋细胞比值越低,CD8＋细胞比例越高;Ⅰ、Ⅱ期结直肠癌患者与Ⅲ、Ⅳ期患者之间差异有显著性（P〈0.05）。结论：FOLFOX方案治疗结直肠癌疗效肯定,可改善患者生存质量,而且对机体免疫力影响小。检测淋巴细胞亚群对判断患者的免疫功能、预测肿瘤患者的预后以及指导临床是否需要应用免疫增强剂均有重要意义。     

Haematologic Parameters in Metastatic Colorectal Cancer Patients Treated with Capecitabine Combination Therapy

Background: The standard treatment in the metastatic colorectal cancer consists of 5-FU based infusionalregimens. However, with oral fluoropyrimidines, equal tumor responses may be obtained. Capecitabine causesmacrocytosis of the cells by inhibition of DNA synthesis. In this context, a relationship was found between meancorpuscular volume (MCV) and response to therapy in breast cancer patients treated with Capecitabine, butwhether this relationship also pertains in colorectal cancer has not been established. Materials and Methods: Atotal of 102 metastatic colorectal cancer patients treated with a oxaliplatin (XELOX)±Bevacizumab combinationwere retrospectively evaluated. Patients were randomized into three groups. Hematological parameters (MCV,MPV, PCT, PLT, NLR) were recorded retrospectively, before treatment and after 3 cycles of chemotherapy.Results: After three cycles of therapy, 20 (19.6%) patients had progressive disease (PD), 41 (40.1%) hadstable disease (SD), and 41 (40.1%) demonstrated a partial response (PR). In 62 (60.7%) treatment was withcapesitabin plus XELOX therapy, and in 40 (39.2%) it was XELOX-Bevacizumab combination therapy. Therewas no difference among three groups before the treatment in terms of MCV, MPV, PCT, PLT, and NLR.MCV showed significant increase in chemotherapy response groups (PR and SD). In addition, a significantdecrease was observed for platelet count in chemotherapy response groups. While NLR decrease was seen inonly a PR group, PCT decrease was observed in all three groups. PCT and PLT values were higher in patientsreceiving Bevacizumab. Conclusions: PLT, PCT, MPV, and NLR values were decreased due to Capecitabinebasedchemotherapy, however MCV was increased. PCT and PLT values were higher in patients who receivedBevacizumab than those who did not. MCV, PLT, and NLR can be considered as important factors in predictingresponse to colorectal carcinoma treatment.     

FOLFOXIRI方案一线治疗晚期结直肠癌的研究进展

结直肠癌是最常见的恶性肿瘤之一,晚期结直肠癌的主要治疗手段是全身药物治疗。近年来,两药联合化疗方案FOLFOX或FOLFIRI联合靶向药物抗VEGF单抗或抗EGFR单抗已成为晚期结直肠癌的标准一线治疗方案。氟尿嘧啶、奥沙利铂和伊立替康是结直肠癌的3种主要化疗药物。这3种药物的联合方案FOLFOXIRI在晚期结直肠癌的治疗中越来越重要。FOLFOXIRI较两药联合方案可以显著改善晚期结直肠癌患者的预后,但同时也明显增加了不良反应。如何在保证疗效的前提下降低不良反应是临床上亟需解决的问题。本文将对FOLFOXIRI方案一线治疗晚期结直肠癌的研究进展进行综述。      

The experience of fatigue and other symptoms in patients receiving chemotherapy

Fatigue has been recognized as the most frequently reported symptom of cancer and cancer therapy. There is a lack of research on such aspects as the pattern of fatigue which accompanies treatment, its exacerbating and relieving factors, the different mechanisms of fatigue and its relationship with the factors purported to be related to the fatigue experience. It has been suggested that cancer patients may be those best placed to reveal the likely causes of fatigue. As part of a larger study examining the pattern of fatigue in cancer patients who were undergoing a course of chemotherapy treatment, patients’perceptions of fatigue and tiredness and the nature, pattern and causes of fatigue in relation to cancer and its treatment were obtained. In addition to a diary, interviews were conducted at two time points, at the beginning and end of a cycle of chemotherapy, with over 100 cancer patients. Just under 90% of the sample reported fatigue at some point during a cycle of chemotherapy. The majority of the sample did not consider tiredness and fatigue to constitute the same feelings. Subjects attributed their fatigue to a combination of factors but most frequently mentioned treatment, changes in sleep patterns and other symptoms. Implications for practice and research are outlined.     

CPT-11联合5-FU/CF(FOLFIRI)化疗方案治疗晚期结直肠癌

背景与目的:CPT-11联合5-FU/CF(FOLFIRI)化疗方案是治疗晚期结直肠癌的有效方案.但是,该方案作为一线方案治疗中国晚期结直肠癌患者的资料缺乏,其疗效和安全性仍需进一步确定.本文旨在探讨FOLFIRI方案作为一线治疗方案对中国晚期结直肠癌患者的疗效和安全性.方法:自2002年1月至2005年9月期间,共54例晚期结直肠癌患者采用FOLFIRI方案作为一线方案进行治疗,回顾性分析其治疗有效率(response rate,BR)、疾病进展时间(time to progression,TTP)、总生存时间(overall survival,OS)和不良反应.结果:54例患者中52例可评价疗效.其中RR为42.6%,TTP为6个月,OS为15.2个月.最常见的不良反应为中性粒细胞减少(38.9%)、腹泻(37.1%)和恶心呕吐(50.0%),Ⅲ/Ⅳ级的发生率分别为5.6%、9.3%和9.3%,总体耐受性好.结论:FOLFIRI方案治疗中国晚期结直肠癌患者疗效肯定,作为一线化疗方案有较高的有效性,不良反应可以耐受.     

HCPT联合L-OHP方案治疗进展期结直肠癌的近期临床疗效

Objective： Although 5-fluarouracil-based chemotherapy has become a standard regimen for treatment of advanced colorectal cancer, the efficacy, as second line therapy, is not high. It is necessary to find a new regimen as a substitute for these patients. The study was to evaluate the short-time effects and toxicity of combination of HCPT plus L-OHP regimen in treatment of advanced colorectal cancer. Methods： Forty-seven patients with pathological evidence of advanced colorectal cancer were enrolled and were treated with HCPT plus L-OHP regimen for 86 cycles. All patients were treated with L-OHP 130 mg/m^2 day 1 and HCPT 6 mg/m^2day 1-4, the chemotherapy was repeated every 3 weeks as a cycle. The Short-time efficats and side effects were evaluated after 2 cycles for each patient. Results： 38 cases can be evaluated to short-time effects and achieved the overall response rate （CR＋PR） was 36.8%. KPS improved in 20 cases （52.6%）. In the total 86 cycles, the leucopenia occurred in 59 cycles （68.6%）,18 cycles （30.5%） in grade Ⅲ and Ⅳ and the diarrhea occurred in 48 cycles （55.8%）, 18 cycles （37.5%） in grade Ⅲ and Ⅳ. Conclusion： A satisfied response rate was obtained in advanced colorectal cancer patients treated by HCPT plus L-OHP regimen, especially who were the failure of first-line chemotherapy with 5-FU. The limited-dose toxicity was leucopenia and diarrhea.