放疗同步拓扑替康治疗局部晚期非小细胞肺癌的Ⅱ期临床研究

局部晚期非小细胞肺癌占所有肺癌患者的40%。近年来,随着同步放化疗的应用,局部晚期非小细胞肺癌的长期生存得到了较好改善,但理想的同步化疗方案尚无定论。拓扑替康作为拓扑异构酶I抑制剂,已广泛应用于多种实体肿瘤如小细胞肺癌、非小细胞肺癌、卵巢癌、结肠癌的治疗,并取得一定疗效^[1]。本研究采用放疗同步拓扑替康治疗局部晚期非小细胞肺癌,基于2005年发表的Ⅰ期临床研究的结果进行Ⅱ期前瞻性研究及疗效分析^[2]。     

新冠肺炎疫情期间高校图书馆的微信舆情导向研究

新型冠状病毒感染肺炎的爆发，引起了社会相关舆论爆发式增长。研究疫情期间高校图书馆的微信舆情，可以为日后进行突发公共舆情引导提供解决方案。通过分析2020年1月21日至2月11日期间42所“世界一流大学”建设高校的图书馆微信公众号的推送频次、发文数量、文章内容、发文趋势，发现疫情期间高校图书馆能够响应防控政策、解决读者需求、发挥专业优势进行舆情引导，并提出了高校图书馆建立应对突发事件舆情的相关策略。     

广泛期SCLC化疗后IMRT的疗效分析

目的 回顾研究广泛期SCLC化疗后IMRT的疗效及预后。方法 回顾分析2007—2012年在本院放疗科接受化疗+IMRT的130例初治广泛期SCLC患者,化疗方案以EP、CE方案为主,放疗剂量32 Gy~63 Gy,35例患者进行了PCI。Kaplan-Meier法计算生存率,Logrank法单因素预后分析,Cox模型多因素预后分析。结果 随访率96.1%。全组治疗毒性轻微,≥2级血液学毒性及放射性食管炎发生率分别为22.3%、12.2%,≥2级RP发生率7.7%。放疗后达CR、PR、SD、PD者分别占4.6%、72.3%、6.2%、13.1%,疗效未能评价5例,客观有效率76.9%。中位生存期18个月(4~66个月),1、2年OS率分别为72.3% 、38.3%。30例(23.1%)患者放疗后发生局部区域失败,83例(63.8%)发生远处失败。26例放疗计划可恢复的局部区域失败患者中,22例单纯照射野内失败,2例单纯野外失败,2例野内野外同时失败。单因素分析中年龄、LDH水平、放疗剂量、PCI是影响预后因素(P=0.014、0.049、0.043、0.003),多因素分析中放疗剂量、PCI是影响预后因素(P=0.021、0.007)。初诊无脑转移患者PCI明显改善生存(HR=2.318,95%CI为1.388~3.871;P=0.003)并降低累积脑转移率(18.4%:37.2%,P=0.038)。胸部放疗EQD₂剂量达54 Gy可改善OS (HR=1.615,95%CI为1.016~2.567;P=0.043),并有改善PFS趋势(HR=1.49,95%CI为0.965~2.299,P=0.072)。结论 化疗有效的广泛期SCLC行胸部放疗可提高LC率及OS率,适当提高胸部剂量可改善患者预后。PCI可显著改善OS并降低脑转移发生率。     

广泛期小细胞肺癌化疗后脑预防照射及颅外病变放疗的Ⅱ期临床研究

Objective To investigate the efficacy and safety of thoracic radiotherapy (TR) and prophylactic cranial irradiation (PCI) in patients with extensive small cell lung cancer (SCLC) who show response to chemotherapy. Methods From July 2010 to March 2012, 30 patients with a pathological or cytological diagnosis of extensive SCLC who showed response to 4-6 cycles of chemotherapy with carboplatin plus etoposide or chemotherapy with cisplatin plus etoposide were included in the study. The median age of patients was 57 years (range, 40-71 years). All the patients received TR (50-60 Gy) and PCI (25 Gy). The short-term efficacy was assessed by RECIST 1.1, and the toxicities were evaluated according to CTCAE 3.0 and RTOG radiation morbidity scoring criteria. Results Twenty-nine of the 30 patients completed the TR and PCI. Of these patients, 13% showed complete remission, 27% showed partial remission, and 60% showed stable disease, and the disease control rate was 100%. Progression was seen in 16 patients after effective treatment, including 1 patients with locoregional failure (LRF) alone and 15 patients with distant failure (DF)(9 patients with DF alone and 6 patients with locoregional and distant metastases, 4 patients with brain metastasis). The follow-up rate was 100%. The 1-year LRF rate and DF rate were 24% and 51%, respectively. The 1-year overall survival rate and disease-free survival rate were 71% and 37%, respectively. The acute toxicities included grade ≥2 hematological toxicity and grade ≥2 radiation esophagitis, which occurred in 33% and 13% of all patients. Conclusions TR and PCI have good short-term efficacy and safety in extensive SCLC patients with response to chemotherapy and can reduceDOI:10.3760/cma.j.issn.1004-4221.2013.05.007基金项目:北京希望马拉松专项基金(N2010-8)作者单位:100021 北京协和医学院中国医学科学院肿瘤医院肿瘤研究所放疗科(张文珏、周宗玫、陈东福、梁军、冯勤付、张红星、王小震、惠周光、肖泽芬、吕纪马、王绿化),内科(李峻岭)通信作者:周宗玫,Email:zhouzongmei2013@163.combrain metastases and local recurrence. However, further study is needed with a larger sample.