What are the long-term complications of pediatric ALL treatments and how can they be mitigated? Perspectives on long-term consequences of curative treatment in childhood ALL

Despite cure rates approaching 100% for some subsets of patients, survivors of childhood acute lymphoblastic leukemia (ALL) report a multitude of short- and long-term side effects. Indeed, the long-term complications of pediatric ALL treatment regimens can be associated with significant morbidity and mortality. Identifying mitigation strategies and developing more effective, less toxic therapies is a central goal of current research.     

胸段食管鳞癌根治性放化疗IFI和ENI前瞻性多中心随机对照临床研究

目的 比较胸段食管鳞癌根治性放化疗采用IFI和ENI照射的不良反应、失败模式和长期生存。方法 符合入组条件胸段食管鳞癌采用随机数字表法分为IFI或ENI组。主要观察终点为急性放化疗不良反应,次要观察终点为失败模式、PFS和OS。Kaplan-Meier法计算生存率,Logrank法检验差异。结果 2012—2016年9个试验中心共筛选食管鳞癌患者 228例,最终可分析的患者ENI组 101例,IFI组 104例。IFI组≥2级急性放射性食管炎和放射性肺炎的发生率明显低于ENI组(P=0.018,0.027)。ENI组和IFI组在总失败率、局部区域失败率、远处转移率、野内和野外淋巴结复发率等均相近(P=0.401、0.561、0.510、0.561、0.681)。ENI组与和IFI组1、2、3、4年OS率和中位OS期分别为84.1%、57.3%、39.4%、31.6%和28个月与83.6%、62.1%、44.5%、31.5%和32个月(P=0.654);1、2、3年PFS率和中位PFS期分别为71.9%、42.3%、32.7%和20个月与70.1%、45.0%、35.9%和22个月(P=0.885)。结论 与ENI相比,胸段食管鳞癌采用IFI照射可减少急性放射性食管炎和肺炎发生率,而不会降低局部-区域淋巴结和肿瘤控制率及远期生存。临床试验注册 临床试验注册中心,注册号:NCT01551589。     

Nimesulide-Induced Severe Hemolytic Anemia and Acute Liver Failure Leading to Liver Transplantation

We present the case of a 63-year-old woman who had undergone 7 months of treatment with Nimesulide (100 mg/b.i.d.) for symptomatic osteoarthritis. The patient was admitted to our unit with a clinical picture of progressive jaundice over 3 weeks. Clinical and analytical studies revealed acute liver failure, this being confirmed by liver biopsy, which showed submassive necrosis. Serological tests for different viral agents causing hepatitis were all negative. In addition, she presented a picture of severe haemolytic anaemia resistant to several treatments and needed multiple transfusions. Twenty-three days after admission, the patient presented hepatic encephalopathy and received an orthotopic liver transplant on day 25. The evolution after transplantation was good and the patient continues in good health with no evidence of haemolysis almost 2 years later. Liver toxicity due to Nimesulide is well known, but to our knowledge the occurrence of haemolytic anaemia has not been related to this drug previously. For these reasons, Nimesulide has been restricted or removed from the market in several countries in recent months.     

头颈部鳞癌术后同步放化疗的临床疗效观察

目的探讨术后同步放化疗对局部晚期头颈部鳞癌的疗效。方法将术后局部晚期头颈部鳞癌患者146例随机分为观察(组（73例）和对照组（73例），均给予放疗，常规分割，总剂量50?Gy。观察组在放疗同时给予DDP 15?mg/(m2·周)化疗。结果观察组和对照组2年的局部控制率分别为79％和64%（P=0.042），3年无瘤生存率分别为49％和33％（P=0.043），3年总生存率分别为61％和49％（P=0.134），3年局部复发率分别为21％和35％（P=0.042），3年远处转移率分别为23％和27％（P=0.568）。Ⅲ、Ⅳ级骨髓抑制发生率分别为38％和15％（P＜0.001）；Ⅲ、Ⅳ级放射性黏膜损伤发生率分别为55％和29％（P＜0.001）。结论术后同步放化疗疗效优于术后单纯放疗，但未改善总生存率及远处转移率。