放疗化疗联合治疗局部晚期非小细胞肺癌43例

目的 探讨以顺铂为主的化疗方案加放疗对局部晚期非小细胞肺癌的疗效。方法 86例局部晚期非小细胞肺癌患随机分为治疗组及对照组各43例，放疗方案以CAP、EP、MVP或MOP，每人至少化疗两个周期，化疗后10～14天放射治疗，放疗采用^60Co外照射。结果 治疗组有效率83．7％，中位生存期14．5个月，对照组有效率67．4％，中位生存期10个月，两组不良反应为骨髓抑制、胃肠道反应。结论 以顺铂为主的化疗方案加放疗治疗局部晚期非小细胞肺癌的疗效较高，可提高肿瘤的局部控制率和延长生存期。     

腹壁下动脉插管化疗在子宫颈及阴道恶性肿瘤的应用

我科6年中对子宫颈及阴道恶性肿瘤施行腹壁下动脉插管化疗共34例,作为配合放疗及争取手术的综合疗法之一,提高晚期宫颈癌的放疗效果,对Ⅱ期早宫颈癌施行根治术者6例,但对腺癌、肉瘤及恶性黑色素瘤等效果差。     

多希紫杉醇联合顺铂治疗晚期非小细胞肺癌疗效观察

目的观察和评价多希紫杉醇联合顺铂(DP方案)治疗晚期非小细胞肺癌的疗效和毒性。方法将我科近几年收治的48例晚期非小细胞肺癌患者随机分为治疗组和对照组。治疗组采用多希紫杉醇联合顺铂(DP方案),对照组采用长春瑞滨联合顺铂(NP方案)。2周期化疗后进行疗效、毒性对比研究。结果治疗组和对照组近期有效率分别为45.5%和37.5%,疾病进展时间(TTP)分别为6.3和5.9个月,中位生存期分别为10.1和9.0个月,1年生存率分别为45.8%和39.4%,两组间比较差异均无显著性(P>0.05)。治疗组在恶心呕吐、骨髓抑制等毒性反应发生率方面低于对照组,差异有显著性(P<0.05)。结论多希紫杉醇联合顺铂治疗晚期非小细胞肺癌与NP方案相比较,疗效相似,但毒性反应低于NP组,患者更易耐受,可广泛应用于临床。     

潘生丁增强氨甲蝶呤的抗肿瘤作用

外源性核苷能抵消抗代谢药对肿瘤细胞的杀伤作用;核苷转运抑制剂潘生丁则能阻断核苷的这种抵消作用,从而增强抗代谢药的细胞毒性。本研究证明,胸苷和次黄嘌呤可明显抵消氨甲蝶呤对L1210细胞的杀伤作用,潘生丁则能有效地阻断核苷的抵消作用;潘生丁和两性霉素B合用可明显增强氨甲蝶呤对小鼠S180肉瘤的抑制作用,但不增强氨甲蝶呤对动物的毒性。提示潘生丁有可能应用于肿瘤联合化疗。     

改进后的腹腔镜腹腔内补片术在疝修补中的应用(附316例临床分析)

目的 腹腔镜腹腔内补片植入术(IPOM)，因有补片引起腹内组织粘连引发肠梗阻甚至复发等报道，目前争议较多，未能推广应用。作者改进了以上方法的多个步骤以克服该方法的不足。探讨改进后的方法在成人疝修补中的应用价值。方法 以缝合小儿疝的方法关闭内环口；把补片的中心固定在疝环口的中心：经腹壁用可吸收线代替钉合枪以针织的方法把补片四周牢牢地固定并展平紧贴在腹膜上。利用脐内侧韧带腹膜覆盖网片的内侧：减少网片外露的面积，减少粘连发生。结果 具有容易与腹膜相融合特性的网片能很快地与腹膜融合成一柔韧性组织，加强了疝环薄弱区，极少引起腹内肠管的粘连，更没有肠梗阻的发生，复发率低。结论 作者认为经过改进后的IPOM方法是一种效果确切、创伤少、并发症少、费用低、有微创优点。值得继续探索应用。     

Immediate versus delayed chemotherapy in patients with asymptomatic incurable metastatic cancer

Aim: To examine the evidence of benefit in initiating immediate chemotherapy in patients with newly diagnosed asymptomatic metastatic incurable cancer, compared with delaying chemotherapy until symptomatic progression. Methods: Through an extensive review of published reports, we examined the biological, clinical, psychological and ethical background of the issue and reported on the available clinical trial evidence in a variety of tumor types. Results: Only a limited number of clinical trials have directly examined the role of immediate versus delayed chemotherapy in patients with incurable asymptomatic metastatic cancer. Small studies in mesothelioma, colorectal cancer, breast cancer, myeloma, and low‐grade lymphoma suggest no survival benefit for the immediate initiation of chemotherapy. However, there was no evidence in other tumor types. Conclusion: The appropriate timing of chemotherapy initiation in an asymptomatic patient with metastatic cancer remains a substantial question in oncology. Many factors are likely to impact on the decision. However, little if any evidence demonstrates a clear advantage in the immediate initiation of chemotherapy in this setting.     

Progression-free interval in ovarian cancer and predictive value of an ex vivo chemoresponse assay

The study objective was to determine the effectiveness of a phenotypic chemoresponse assay in predicting response to chemotherapy measured by progression-free interval (PFI) in a retrospective series of ovarian cancer patients whose tumor specimens had been tested with the ChemoFx assay. A statistically significant correlation between assay prediction of response and PFI was observed in 256 cases with an exact or partial match between drug(s) assayed and received. In 135 cases with an exact match, the hazard ratio for progression of the resistant group was 2.9 (confidence interval [CI]: 1.4-6.3; P < 0.01) compared to the sensitive group and 1.7 (CI: 1.2-2.5) for the intermediate compared to the sensitive group. The median PFI for patients treated with drugs assayed as resistant was 9 months, 14 months for those with drugs assayed as intermediately sensitive, and PFI had not been achieved for those with drugs assayed as sensitive. These data indicate that the ChemoFx assay is predictive of PFI in ovarian cancer. As the majority of ovarian cancers display different degrees of response to different chemotherapy agents ex vivo, the incorporation of assay information into treatment selection has the potential to improve clinical outcomes in ovarian cancer patients.     

雾化吸入IL-2联合化疗对原发性非小细胞肺癌疗效观察

观察雾化吸入ＩＬ－２联合化疗对非小细胞肺癌的临床疗效并与静滴ＩＬ－２及单纯化疗进行对比。方法：ＩＬ－２的雾化１０万ｕ／次，２次／ｄ，连用１月，化疗后３ｄ开始用；ＩＬ－２静滴４０万ｕ／次，１次／ｄ，加入５００ｍｌ液体中静滴，连用１月；化疗采用动脉灌注或全身化疗，药物及剂量为环磷酰胺４００ｍｇ／ｍ２＋ＤＤＰ８０ｍｇ／ｍ２。结果：用ＩＬ－２的两组ＣＲ＋ＰＲ显著高于单纯化疗组（Ｐ＜０．０１）；雾化ＩＬ－２组ＣＲ＋ＰＲ与静滴ＩＬ－２差别无显著性（Ｐ＞０．０５），但不良反应的发生率显著低于后者，而与单纯化疗类似，结论：雾化吸入ＩＬ－２联合化疗对非小细胞肺癌有较好的疗效，且副作用小，值得扩大样本进一步验证其疗效。