Capecitabine and vinorelbine in elderly patients (> or =65 years) with metastatic breast cancer: a phase I trial (SAKK 25/99).

BACKGROUND: Few chemotherapy regimens are suitable for the treatment of elderly patients with advanced breast cancer. With the aim of finding a regimen with a low burden of subjective non-overlapping toxic effects, vinorelbine and capecitabine were chosen to be investigated in a phase I dose-finding study. PATIENTS AND METHODS: Thirty-six patients with advanced breast cancer were stratified for the presence of bone and non-bone involvement and treated at four dose levels from capecitabine 800 mg/m2 orally days 1-14 and vinorelbine 20 mg/m2 intravenously days 1 and 8, to capecitabine 1250 mg/m2 orally days 1-14 and vinorelbine 25 mg/m2 intravenously days 1 and 8, for a maximum of six cycles. None of the patients had received prior chemotherapy for metastatic/advanced disease. Fifty-three per cent of patients with bone metastases and 67% of patients without bone metastases had visceral disease. The median age was 70 years for the 15 with bone involvement patients and 73 years for the 21 without bone involvement patients. RESULTS: Twenty-eight patients were fully evaluable for hematological dose-limiting toxicity (DLT), and all patients for other DLTs and for antitumor activity. One DLT with grade 3 venous thrombosis at dose level 2 and two dose-limiting neutropenia events at level 3 occurred in patients without bone involvement. Two dose-limiting neutropenia events were observed at dose level 2 for patients with bone involvement. Thus, the recommended dose was defined at level 1 (capecitabine 1000 mg/m2 days 1-14 and vinorelbine 20 mg/m2 days 1 and 8) for patients with bone involvement. For patients without bone involvement, the recommended dose was at level 2 (capecitabine 1250 mg/m2 days 1-14 and vinorelbine 20 mg/m2 days 1 and 8). For patients without bone involvement the overall response rate was 48% and the time to progression (TTP) was 4.5 months [95% confidence interval (CI) 3.3-6.9]. For patients with bone involvement the overall response rate was 53% and TTP was 5.3 months (95% CI 2.7-7.8). CONCLUSIONS: This regimen of capecitabine and vinorelbine is well tolerated and effective in elderly patients with metastatic breast cancer. Toxicity was mainly hematological and was observed at a lower dose in patients with bone involvement. A phase II study with the two different dose levels for elderly patients with and without bone involvement is currently being conducted.     

Symptoms of Early Cancer Especially Barrett''''s Carcinoma

The incidence of the adenocarcinoma of the esophagus (AC) has been rising exponentiallyin the Western World within the last 30 years.The reasons for this increase are not yet understood.Massive and long lasting gastroesophageal reflux causes the Barrett's esophagus which is considered tobe a precaneerosis.Therefore early diagnosis and appropriate treatment of gastroesophageal reflux isessential for the prevention of this tumor.This makes heartburn the leading clinical symptom in thepatient's history.In patients with heartburn it is possible to early endoscopically diagnose a Barrett'sesophagus or adenocarcinoma of the esophagus.However only few patients with this increased risk receivean index-endoscopy.In clinical studies a high rate of early carcinomas could be found and could be treatedwith mueosectomie or ablation.The majority of patients with AC present with symptoms suggestive ofprogressed disease such as dysphagia or weight loss.The prognosis in patients in late disease stages are witha 5-year survival of only 30% far worse than in patients with early carcinoma (85%).However the earlysymptoms such as heartburn or regurgitation are unspecific and make an effective diagnostical strategydifficult.To optimize screening it would be beneficial to identify patients with high risk for the developmentof adenocarcinoina of the esophagus.     

影响贲门癌手术患者预后的相关因素分析

目的：探讨影响贲门癌患者生存时间的影响因素。方法：收集236例贲门癌患者临床资料和随访资料，使用单因素Log-rank检验、Cox比例危险模型对影响预后的因素进行单因素、多因素回归分析。结果：肿瘤长度、淋巴结转移、组织病理学类型和TNM分期对患者的预后有影响。结论：早发现、早治疗是提高患者生存率的关键。     

从《黄帝内经》看秦汉时期的推拿学成就

《黄帝内经》中 ,关于推拿的记载 ,虽然少而杂 ,但其内容涉猎十分广泛 ,包括推拿的理论及临床等多个方面。从中可以看出 ,秦汉时期的推拿学与其他学科相比较 ,不仅广泛地应用于临床医疗和保健 ,并且在理论上形成一定的体系 ,成为中医学中发展较早的学科之一。同时推拿的临床实践 ,为后世中医基本理论的形成提供了实践依据     

脾胃学说与儿科临证

通过中医古代文献对脾胃在人体生命活动中作用的论述 ,结合小儿的生理病理特点 ,总结归纳脾胃学说与儿科临床的重要意义 ,并指导儿科疾病的预防及治疗     

肺癌术后支气管切缘癌发生的相关因素分析

目的　探讨肺癌术后支气管切缘癌发生的相关因素。方法　对 2 43例原发性非小细胞肺癌患者的病例资料进行回顾性分析 ,采用Logistic回归分析判断术后支气管切缘癌发生的相关因素。 结果　 2 43例肺癌患者中 ,支气管切缘癌发生 3 1例 ,发生率为 12 .8% ,多因素分析显示 ,中央型肺癌、肺叶支气管淋巴结转移及组织学类型为鳞癌是支气管切缘癌发生的危险因素。结论　中央型肺癌、肺叶支气管淋巴结转移及组织学类型为鳞癌的肺癌病例应考虑发生术后支气管切缘癌的可能     

中医识脑

通过中医文献复习分析,指出脑是神智活动的主宰器官,脑主感知、记忆、运动和调节适应等神智活动;脑髓是脑功能活动的物质基础;脑的生长发育根于肾。     

益气化瘀补肾法对颈椎病动物椎间盘病理变化与Ⅱ型胶原mRNA表达的影响

目的 :观察益气化瘀补肾法对颈椎病动物退变椎间盘病理变化及髓核Ⅱ型胶原mRNA表达的影响。方法 :把健康成年新西兰大白兔随机分为益气化瘀补肾组、消炎痛组、模型对照组和正常对照组 ,运用静力平衡失调颈椎病动物模型 ,造成动物椎间盘的退变 ,然后分别喂以相应药物或医用淀粉胶囊 ,观察24周后 ,取颈6/7椎间盘 ,用HE染色法观测椎间盘组织病理变化 ,用生物素标记原位杂交法观测椎间盘髓核组织内细胞Ⅱ型胶原mRNA的表达 ,并运用图像分析仪对其进行数据转换 ,采用SPSS统计软件分析。结果 :益气化瘀补肾法对退变椎间盘病理变化的影响不显著 ,但对椎间盘髓核组织内Ⅱ型胶原mRNA表达的影响有显著作用。结论 :益气化瘀补肾法对颈椎病动物退变椎间盘髓核组织胶原的形成过程的环节有正面影响。     

6例乳腺鳞癌的临床分析

目的：分析乳腺癌的临床特征及治疗方法。方法：回顾性地分析了自1958年建院以来10941例乳腺癌患者中的6例乳腺鳞癌的临床特征，治疗方法及结果。结果：乳腺鳞癌的发病率很低，在我院占所有乳腺癌的0.05％，年龄在42-76岁之间，中位年龄46岁，所有的肿瘤患者均进行手术治疗，绝大部分进行了放疗，只有2例进行了化疗，无瘤生存期差别较大。由于年代较久，有很多项目未做或不清，失访严重。结论；乳腺鳞癌的发病率非常低，确诊需要有较清楚的鉴别诊断，特别是鳞状化生。尚无可推荐的标准治疗方案，有关研究尚应继续进行。     

帕米膦酸二钠(博宁)联合153Sm-EDTMP治疗骨转移癌疗效分析

目的　观察帕米膦酸二钠联合153Sm -EDTMP治疗骨转移癌的疗效、毒副作用并探讨其临床意义。方法　随机入组 71例骨转移癌患者 ,分别给予帕米膦酸二钠、153Sm -EDTMP以及帕米膦酸二钠联合153Sm -EDTMP治疗 ,对照并观察止痛效果及毒性。结果　帕米膦酸二钠、153Sm -EDTMP以及帕米膦酸二钠联合153Sm -EDTMP组的止痛有效率分别为 67%、67%和 88 5 % ,P >0 .0 5 ,提示全组差异无显著性 ,但以 χ2 分割法检验则联合组与其它单用组之间的差异有显著性 (P <0 .0 5 ) ,而毒副反应无显著性差异。结论　帕米膦酸二钠联合153Sm -EDTMP治疗骨转移癌所致疼痛有更好的疗效