TP及BCNU同步全脑放射治疗非小细胞肺癌脑转移的临床观察

目的:观察分析TP方案及卡莫司汀(BCNU)同步全脑放射治疗非小细胞肺癌(NSCLC)脑转移的疗效、生存率以及不良反应.方法:32例NSCLC脑转移初治患者接受TP方案.紫杉醇130 mg/m2,24 h持续静脉输注,顺铂(DDP)20 mg/m2,d1～d3,3周为1个周期;脑部放疗与TP方案同时开始,2 Gy/d,5 d/周,脑转移灶1～3个者全脑放疗40 Gy后缩野至60 Gy,脑转移灶＞3个者全脑放疗至40 Gy,放疗开始20 Gy后予BCNU80 mg/m2,d1～d3,6周为1个周期.结果:治疗后84.3%患者神经系统症状得到改善,对脑转移灶有效率为68.7%,对肺原发灶有效率为53.1%,中住总生存期(MST)11.4个月(95%CI为9.48～13.31),1、2和5年生存率分别为40.6%、18.2%和7.3%,单纯脑转移MST 13.0个月,显著高于多脏器转移9.7个月(P=0.035).常见不良反应为白细胞减少,Ⅲ～Ⅳ度发生率50.0%,经对症治疗后好转,恶心、呕吐,肌肉关节痛以Ⅰ～Ⅱ度为主.结论:TP方案及BCNU联合全脑放射治疗NSCLC脑转移的近期疗效高并延长了中位生存期,毒副反应耐受性好,可考虑作为NSCLC脑转移的治疗方案.     

马蔺子素与放疗合用治疗中晚期鼻咽癌疗效分析

目的评价马蔺子素与放疗合用治疗鼻咽癌疗效.方法用60Co-γ射线常规外照射,包括鼻咽部原发灶及颈部淋巴结转移灶,原发灶DT68Gy,颈转移灶(或预防照射DT40Gy)DT60～72Gy,治疗组放疗前1天开始口服马蔺子素,110mg/次,2次/日,连用直至放疗结束.结果半量疗效及全量(结束时)消失率治疗组原发灶66.7%及96.7%,颈淋巴结转移灶69.2%及92.3%.对照组原发灶42.9%及71.4%,颈淋巴结转移灶48%及60%.半量疗效及全量消失率比较原发灶提高23.7%及26.4%,转移灶提高21.2%及32.3%.结论马蔺子素与放疗合用治疗鼻咽癌两组有显著差异(P＜0.05),提示马蔺子素有放射增敏作用.关健词鼻咽癌放射治疗马蔺子素放射增敏     

乳腺癌骨转移疼痛的综合治疗

目的　探讨缓解乳腺癌骨转移疼痛 ,恢复患者活动能力的方法。方法　 31例乳腺癌骨转移患者采用以CMFP或CAFP方案化疗为主 ,辅以放射性同位素或双磷酸盐类药物综合治疗 ,观察治疗后疼痛缓解、活动能力恢复及骨外转移灶的变化情况。结果　全组骨痛缓解率为 87.1 % (2 7/ 31 ) ,功能活动恢复 85 .7% (6/ 7) ,骨外转移灶的有效率为 67.9% (1 9/ 2 8)。结论　以化疗为主的综合治疗 ,不仅能较好地控制骨外转移灶的发展 ,而且能显著地缓解骨痛 ,恢复患者的活动能力     

中晚期鼻咽癌新辅助化疗联合放疗的临床研究

目的　观察不同新辅助化疗方案联合放疗在局部晚期鼻咽癌的疗效及毒副反应。评价含HD DDP方案的临床可行性。方法　 10 0例局部晚期鼻咽癌患者随机分为单纯放射治疗组 46例 (A组 ) ,低剂量新辅助化疗组 2 8例 (B组 ) ,含HD DDP新辅助化疗组 2 6例 (C组 )。化疗方案 :B组DDP总量 10 0～ 12 0mg/ 3～ 5天 ,5 FU 5 0 0～ 75 0mg/天 ,共 5天 ;C组DDP 10 0～ 13 0mg/天 ,第一天用 ,同时水化利尿 2天 ,5 FU剂量同B组 ,B、C组还分别加用ADM、PYM、VCR、MTX、Me CCNU其中之一 ,2 1天为一周期 ,共用 2～ 3周期 ,化疗后 10～ 14天放疗。常规放射治疗 :鼻咽原发灶DT66～80Gy/ 6.5～ 8周 ,颈部转移灶DT60～ 70Gy/ 6～ 7周 ,颈部预防量DT5 0Gy。 结果　所有病例如期完成治疗。放疗 40Gy时 ,颈部转移灶消退率综合组高于单纯放疗组 (C、B、A组分别为 73 .0 7%、64 .2 8%、5 4.3 5 % )。结束时、结束 1～ 2个月后 ,综合组尤其HD DDP组颈部转移灶完全缓解率明显高于单纯放疗组 (C、B、A组分别为 10 0 %、92 .86%、82 .61% )。鼻咽原发灶缓解率亦有提高 (C、B、A组分别为 88.46%、78.5 7%、68.5 7% )。毒性反应主要表现是综合组较单纯放疗组更高的胃肠道反应及 1～ 3级骨髓抑制和脱发 ,B、C组无明显差别 ,无一例肾功能不     

新辅助化疗联合放疗治疗中晚期鼻咽癌的疗效观察

目的研究新辅助化疗在治疗中晚期鼻咽癌(NPC)中的疗效。方法63例中晚期NPC病人随机分为单纯放疗组30例、新辅助化疗联合放疗组33例。化疗方案PFL方案(DDP80mg/m2~100mg/m2,d1;5-FU3.5/m248h;CF0.3,d1),共2~3疗程;化疗后2周常规放射治疗鼻咽癌原发灶DT68.0Gy/7周,颈转移灶DT65.0Gy/6周,颈预防剂量55.0Gy。结果新辅助化疗联合放疗组原发灶及颈转移灶完全缓解率优于单纯放疗组,毒性反应与单纯放疗组相比无明显差异。结论新辅助化疗联合放疗可提高中晚期NPC患者近期肿瘤缓解率,毒性反应可耐受,但远期生存率需进一步观察。     

放射治疗骨转移癌疼痛47例临床分析

目的 观察骨转移癌疼痛放射治疗方法对疼痛的缓解效果。方法47例患者60处骨转移灶均采用6 MV X线放射治疗。剂量方案采用两种方法:A方案:30—51 Gy/10～17f/2～4周,B方案:25～30 Gy/5—6f/1～2周。结果分次方案对疼痛缓解率无明显影响,总有效率均为91.5％,但常规分次放疗3～4次后疼痛缓解,而低分割放疗1—2次后疼痛即缓解。结论 骨转移癌放射治疗止痛效果确切、迅速,副作用小,对大部分病例可采用低分割方案。     

甘氨双唑钠对鼻咽癌放射增敏作用的临床观察

[目的]研究甘氨双唑钠（CMNa）对鼻咽癌放射治疗的增敏作用以及毒副反应。[方法]将46例经病理学确诊的初治鼻咽癌患者分为放射增敏组（A组,放疗加用甘氨双唑钠）和对照组（B组,单纯放疗）。两组放射治疗方法完全相同,整体挡铅法体外常规放射治疗,鼻咽部DT（68～76）Gy/（34～36）次,6～7周,颈转移淋巴结DT（68～72）Gy/（34～36）次,6～7周,颈部预防量DT56Gy/28次,5～6周。A组在放疗前1h静脉滴注CMNa800mg/m2,每周3次,至放疗结束,B组行单纯常规放疗。[结果]放射增敏组和单纯放疗组放疗结束鼻咽癌原发灶CR率分别为87.5%、59.1%（P=0.028）;颈淋巴结转移灶CR率分别为79.1%、45.5%（P=0.018）,放疗后2～3个月,颈淋巴结转移灶CR率分别为87.5%、45.5%（P=0.002）。鼻咽癌原发灶和颈淋巴结转移灶达部分缓解时放射增敏比（SER）分别为1.49和1.40,达完全缓解时SER分别为1.21和1.18。两组患者放疗毒副反应比较差异无统计学意义。[结论]CMNa能提高鼻咽癌放射治疗完全缓解率,降低达缓解时所需剂量,且不增加放疗毒副反应。     

放疗联合吉非替尼治疗Ⅳ期非小细胞肺癌疗效分析

目的:评价放疗联合吉非替尼治疗非小细胞肺癌的疗效及安全性.方法:26例非小细胞肺癌患者,其中女性20例,男性6例,病理诊断均为腺癌,所有患者均伴有骨或脑单发或多发转移.放疗部位包括肺原发灶及骨或脑转移灶,肺原发灶放疗剂量50-60Gy,脑转移灶接受全脑放疗30-40Gy,部分患者采用适形放疗加量10-20Gy.骨转移灶放疗剂量40-46Gy.放疗期间及结束后服用吉非替尼250mg/qd,直至肿瘤进展.结果:所有患者放疗期间均完成吉非替尼治疗,3例出现腹泻,7例伴发呕吐,12例合并皮疹,7例皮肤干燥.放疗联合吉非替尼治疗期间症状缓解率92%,ECOG评分由放疗前平均3分提高到放疗后2分.原发灶有效率(CR+PR)88.5%(23/26).转移灶有效率(CR+PR)73.1%(19/26).最长随访时间20个月,中位生存时间(MST)9.5个月,疾病进展时间(TTP)6.2个月.1年生存率39.1%(9/23).结论:Ⅳ期非小细胞肺癌放疗联合吉非替尼治疗是有效而安全的,对生存时间的影响需进一步观察.     

肺癌放射治疗中放射性脊髓病及存活率

1966年至1985年间收治2600例肺癌患者,其中2008例行放射治疗。少数病例只对转移灶放疗,没有转移的对原发灶及纵膈放疗,少数患者放疗下颈部。在此期间治疗方案亦有所改变。1966年1月到1970年10月治疗方法为组织量Dr48.5Gy5次/周,     

鼻咽癌后程非常规放疗的预后分析

目的 回顾性分析鼻咽癌后程非常规分割放疗后的效果和失败因素.方法 133例初治鼻咽低分化鳞癌患者进入研究.采用6 MV X线照射,原发灶先面颈野常规放疗34.56Gy（1.92Gy/次,1次/d,共18 d）;后缩野为耳前野加速分割放疗1.25～1.50Gy/次,2次/d,6～8 d;再后为耳前野加小野补量1.90Gy/次（上午）与1.30Gy/次（下午）,2次/d,6～8 d;2次间隔时间≥6 h,5/d周.病灶中位剂量78Gy,中位时间47d.颈部淋巴结有转移的常规放疗67Gy,无转移的常规放疗50～55Gy,中位时间43d.结果 T1、T2、T3、T4期局部控制率分别为100%、96.6%、96.6%、78.4%,全组5年总生存率和无瘤生存率分别为73.3%和70.8%.共14项因素用于临床预后分析,其中单因素有8项对5年生存率有影响（P＜0.01）,Cox多因素分析远处转移、下颈和锁骨上以及双侧颈淋巴结转移、鼻咽复发均有统计学意义（P值分别为0.000、0.016、0.044、0.041）.结论鼻咽原发灶和颈淋巴结转移灶局部控制率和生存率均较过去提高,治疗失败和死亡的主要原因是远处转移.     

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.     

Costs associated with complications are lower with capecitabine than with 5‐fluorouracil in patients with colorectal cancer

BACKGROUND:

Capecitabine, an oral alternative to 5‐fluorouracil (5‐FU) in patients with colorectal cancer (CRC), has equal clinical efficacy and a favorable safety profile; however, its use may be limited because of unit cost concerns. In this study, the authors measured the cost of chemotherapy‐related complications during treatment with capecitabine‐ and 5‐FU–based regimens.

METHODS:

Patients with CRC who received at least 1 administration of capecitabine or 5‐FU during 2004 and 2005 were identified from the Thomson MarketScan research databases. Monthly frequency and cost for 23 complications were recorded. Logistic regression was used to predict complication probability. General linear models were used to predict monthly complication cost and total monthly expenditure.

RESULTS:

In total, 4973 patients with CRC met the inclusion criteria for this analysis. Although the most frequently observed complications were the same between capecitabine and 5‐FU (nausea and vomiting, infection, anemia, neutropenia, diarrhea), each was observed with greater frequency in 5‐FU–based regimens. The mean predicted monthly complication cost was significantly higher (by 136%) with 5‐FU monotherapy than with capecitabine monotherapy (difference, $601; 95% confidence interval [95% CI], $469‐$737). In addition, the mean predicted monthly complication cost for 5‐FU+oxaliplatin was higher than the cost with capecitabine plus oxaliplatin (difference, $1165; 95% CI, $892‐$1595). When acquisition, administration, and complication costs were taken into consideration, there were no significant differences in the total cost between capecitabine regimens and 5‐FU regimens.

CONCLUSIONS:

Capecitabine compared well with 5‐FU–based therapy in patients with CRC and was associated with lower complication rates and associated costs. Cancer 2009. © 2009 American Cancer Society.