不同剂量rhG-CSF预防晚期非小细胞肺癌化疗后白细胞减少的临床研究

背景与目的：肿瘤化疗最常见的剂量限制性毒性是骨髓抑制,其中白细胞和中性粒细胞减少最为常见。骨髓抑制不但使化疗药物的剂量提高受到限制,而且影响了化疗的正常进行。基因重组人粒细胞集落刺激因子(recombinant human granulocyte colony-stimulating factor,rhG-CSF)不仅具有刺激粒细胞集落形成的能力,也有促进粒细胞生长、增殖和分化的能力,对化疗所致白细胞和中性粒细胞减少具有明显疗效。本研究观察晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者接受化疗后预防性应用低、中、高3种不同剂量的rhG-CSF升白效果及不良反应,探讨该药合理的应用策略。方法：126例经病理证实为晚期NSCLC化疗的患者,按数字随机法分为A、B、C共3组。3组患者于化疗结束后24 h给予rhG-CSF。其中A组(低剂量)：rhG-CSF300 μg,皮下注射,每日1次,共1天;B组(中剂量)：rhG-CSF 300 μg,皮下注射,每日1次,共2天;C组(高剂量)：rhG-CSF 300 μg,皮下注射,每日1次,共3天。观察患者用药后出现的症状和体征以及rhG-CSF的不良反应。结果：化疗后预防性使用中、高剂量rhG-CSF可以使近60%的患者白细胞高于4.0×10⁹个/L;对于Ⅲ级白细胞减少的患者,低剂量组白细胞水平回升天数更长,高剂量组白细胞回升天数明显缩短,高剂量组和低剂量组之间差异有统计学意义(P<0.05);从中性粒细胞的动态变化情况来看,化疗后加用高剂量rhG-CSF可以提高中性粒细胞的平均水平,能明显缩短化疗引起中性粒细胞低下的持续时间。126 例患者中感染发生率为4.76%,其中低剂量组为9.52%,中剂量组为4.76%。rhG-CSF引起的不良反应轻微,患者能耐受。结论：化疗后预防性使用不同剂量rhG-CSF 均可促进化疗患者白细胞和中性粒细胞的恢复,降低感染发生率。在相同化疗剂量下选用高剂量的rhG-CSF可使白细胞和中性粒细胞水平快速上升,安全可靠。     

直肠癌术后肝转移患者FOLFIRI化疗后肠道黏膜功能变化分析

目的:探讨直肠癌手术治疗后发生肝转移患者采用FOLFIRI方案（5-氟尿嘧啶+四氢叶酸钙+伊立替康）化疗对患者肠道黏膜功能的影响作用。方法:观察我院肿瘤科2011年9月至2013年8月收集的55例直肠癌术后发生肝转移患者采用FOLFIRI化疗方案前后肠道黏膜功能的变化情况,检测化疗前与化疗后不同时间患者血清白蛋白、前白蛋白、血浆D-乳酸、尿液中乳果糖/甘露醇（L/M）值、血浆内毒素值的水平。结果:55例患者血清白蛋白化疗前为（37.62±1.72）g/L、前白蛋白为（367.4±7.3）mg/L,均显著高于化疗后第1、3、7、9天(P<0.05),化疗后第9天的血清白蛋白、前白蛋白化疗后第7天有所升高（P<0.05）。化疗后第1、3、7、9天的血浆D-乳酸水平较化疗前明显升高（P<0.05）。与化疗前相比,化疗后第1、3、7、9天的L/M值表现为逐渐上升趋势,化疗后第9天的L/M值显著高于化疗前（P<0.05）。化疗前本组患者均无腹痛、腹泻发生,随着化疗时间的延长,化疗患者的腹痛、腹泻率逐渐增高,在化疗第7天达到最高值（腹痛率87.27%、腹泻率34.55%）,在化疗后第9天有所降低（腹痛率83.64%、腹泻率27.27%）。结论:直肠癌术后肝转移患者采用FOLFIRI方案治疗会引起肠道黏膜功能障碍,肠道通透性增加。     

PICC对化疗患者血浆D-二聚体水平的影响

 目的 探讨化疗患者PICC前后D-二聚体水平变化及影响因素分析。方法 分析100例PICC置管后行化疗的恶性肿瘤患者,采用乳胶增强免疫比浊法检测置管前1周内及置管后4周内D-二聚体水平。PICC前后D-二聚体水平比较采用两相关样本Wilcoxon秩和检验,各组间比较采用两独立样本Wilcoxon秩和检验或多组独立样本Kruskal-Wallis H检验。结果 PICC前糖尿病患者D-二聚体水平1.330（0.463, 1.828）μg/ml较非糖尿病患者0.530（0.290, 0.965）μg/ml高（P=0.021）,其他组间比较差异无统计学意义（P>0.05）。整体水平上,PICC置管后的D-二聚体水平1.010（0.593, 1.568）μg/ml较置管前0.670（0.330, 1.293）μg/ml上升（P<0.001）。PICC前后D-二聚体水平差值,肿瘤分期为Ⅳ期者0.400（0.055, 0.750）μg/ml较Ⅱ/Ⅲ期者0.160（-0.170, 0.360）μg/ml高（P=0.010）;年龄≥60岁者为0.470（0.160, 0.790） μg/ml较<60岁者0.110（-0.060, 0.370）μg/ml高（P=0.001）,其他组间比较差异无统计学意义（P>0.05）。结论 PICC使化疗患者D-二聚体水平上升,其危险因素包括肿瘤分期为Ⅳ期及年龄≥60岁。     

rhG-CSF促进白血病化疗后骨髓抑制恢复的临床观察

解决化疗后骨髓抑制的问题.是白血病治疗成功的关键.本文对20例急性白血病,中位年龄39岁.ANLL 18例,ALL 2例,在化疗后外周血WBC明显下降时(WBC0.15～0.5×10~9/L13例,0.55～0.9×10~9/L6例,14×10~9/L1例)开始用rhG-GSF治疗,剂量为:75μg/d 2例,150μg/d 13例.225μg/d4例;300μg/d1例,除1例外,余均为皮下注射,13/20例在完成化疗后1～7天用药,用药3天5例,4～7天11例,8～14天4例.结果化疗后骨髓抑制期,治疗组中位天数14(7～28)天,对照组中位天数20(8～38)天(p<0.05);化疗后发热     

肝癌肝移植术后辅助化疗的临床分析

目的探讨晚期肝癌患者肝移植术后辅助化疗的可行性、安全性和疗效。方法分析10例原发性肝癌患者肝移植术后辅助化疗的临床资料。化疗采用FAP方案：四氢叶酸钙(CF)200mg／m^2,5-氟尿嘧啶(5-Fu)500mg/m^2,静脉滴注,第1～5天;阿霉素(ADM)40mg/m^2,顺铂(CDDP)30mg/m^2,静脉滴注第1天。对化疗时机、化疗方案、免疫抑制剂和化疗的协同作用以及化疗药物的副作用进行初步评价。结果10例患者至今存活7例,最长32个月,最短9个月;死亡3例,生存期均超过了1年,其中2例死于术后13个月,1例死于20个月,死亡原因均为肿瘤转移。化疗毒副反应轻。结论肝癌患者肝移植术后辅助化疗是可行的、副作用小,有可能延长患者生存期;选择化疗时间对肿瘤复发和患者生存率可能有影响。     

国产G-CSF治疗门诊化疗患者的白细胞减少

目的:评价rhG-CSF(国产瑞白)治疗门诊患者化疗后白细胞减少的作用和不良反应。方法:52例患者,均为病理或细胞学证实的恶性肿瘤。在化疗后白细胞计数<2.9×109/L时给予rhG-CSF(国产瑞白)100μg,每日1次,皮下注射,连续5天。结果:rhG-CSF(国产瑞白)100μg,每日1次,连续5天。治疗后可明显增加门诊患者化疗后的白细胞计数,使化疗按期完成,不同原发肿瘤、转移部位、既往是否化疗以及不同化疗方案之间均无显著差别。结论:rhG-CSF(国产瑞白)100μg,每日1次,皮下注射连用5天是门诊化疗患者有价值的辅助治疗手段。     

102例术后乳腺癌辅助化疗后贫血相关因素分析

[目的]探讨乳腺癌术后辅助化疗后贫血发生的相关因素.[方法]回顾性分析102例乳腺癌辅助化疗病人化疗前及每周期化疗后血红蛋白值,按分期分组观察每周期化疗后贫血发生率;按手术方式分组观察每周期化疗后贫血发生率;按化疗前血红蛋白水平分组观察每周期化疗后贫血发生率.[结果]Ⅰ、Ⅱ、Ⅲ期病人,化疗后贫血发生率无显著性差异(P＜0.05),乳房切除术的病人,贫血发生率高于乳房保留术的病人(3周期后P＜0.05,4周期后P＜0.01),化疗前血红蛋白水平低于110g/L的病人,与化疗前血红蛋白水平高于等于110g/L的病人相比,化疗后贫血发生率升高;化疗前血红蛋白水平＜120g/L的病人,与化疗前血红蛋白水平高于等于120g/L的病人相比,化疗后贫血发生率升高.[结论]乳腺癌术后接受辅助化疗的病人,贫血发生率与临床分期无关,与手术方式有关.     

红细胞生成素对小鼠化疗所致贫血的预防作用

 目的　探讨红细胞生成素对小鼠化疗所致贫血的预防作用。方法　小鼠左侧腹股沟皮下接种S180 肉瘤细胞 ,接种肿瘤前 12天 ,给以rHuEPO皮下注射 ;接种前 4天 ,小鼠尾静脉注射卡铂诱导贫血 ;接种肿瘤后 5天 ,小鼠腹腔注射环磷酰胺化疗 ;动态观察小鼠血红蛋白变化。结果　环磷酰胺化疗时 ,EPO +卡铂组Hb为 16 2 .6 g/L ,卡铂组134.9g/L(P <0 .0 5 ) ;CTX治疗后 5天 ,EPO +卡铂组Hb为 137.5g/L ,卡铂组12 6 .7g/L(P <0 .0 5 )。结论　小鼠化疗前应用rHuEPO可以有效预防化疗所致贫血的发生或减轻化疗所致贫血的程度     

胃癌根治术后全身静脉化疗联合腹腔区域性化疗30例分析

目的　探讨胃癌根治术后腹腔区域性化疗的疗效。方法　治疗组 3 0例胃癌行根治性切除 (D2 、D3 )手术 ,同时术中安置腹腔化疗泵 ,术后全身静脉化疗联合腹腔区域性化疗。术后每月化疗 ,第 1天用 5 Fu 15 0 0mg DDP 60mg NS10 0 0ml经腹腔化疗泵缓慢滴入 ;第 2天全身静脉化疗 ,CF 2 0 0mg/m2 × 5天 ,5 Fu 75 0mg/m2 × 5天 ,分别加入NS 5 0 0ml静脉滴注 ,MMC 4mg加入NS 2 0ml静脉注射× 1天 ,2 8天为 1个疗程 ,连用 6个疗程。对照组 3 0例胃癌根治性切除术后仅行全身静脉化疗 ,化疗方法同治疗组。结果　治疗组 3 0例 1、2、3年复发率分别为 10 .0 %、3 3 .3 %、43 .3 %。生存率分别为 93 .3 %、80 .0 %、66.6% ,对照组3 0例 ,1、2、3年复发率分别为 3 0 .0 %、63 .3 %、73 .3 %。生存率分别为 83 .3 %、60 .0 %、40 .0 %。结论　胃癌根治术后全身静脉化疗联合腹腔区域性化疗 ,其 2、3、年生存率明显高于对照组 (P <0 .0 5 ) ,其术后肿瘤复发率明显低于对照组 (P <0 .0 5 )。胃癌根治术后辅助全身静脉化疗并联合腹腔区域性化疗 ,可延长胃癌患者术后生存期 ,提高 3年生存率。     

mFOLFOX6方案用于进展期胃癌术后辅助化疗的临床研究

目的观察mFOLFOX6方案用于进展期胃癌术后辅助化疗的临床疗效及不良反应。方法进展期胃癌术后患者29例入mFOLFOX6组,用奥沙利铂85mg/m^2,静脉滴注（〉2h）,第1天;四氢叶酸钙400mg/m^2,静脉滴注（2h）,第1天;氟尿嘧啶0.4g/m^2,静脉推注（四氢叶酸钙之后用）;氟尿嘧啶2.4g/m^2,持续静脉灌注（经化疗泵灌注）46小时。每2周重复1次,2次为1个疗程。同期进展期胃癌术后患者26例入PF组,用顺铂20mg/m^2,静脉滴注,第1～5天;四氢叶酸钙300mg/m^2,静脉滴注（2h）,第1～5天;氟尿嘧啶500mg/m^2,静脉滴注（四氢叶酸钙之后用）,第1～5天;每3周重复1次,为1个疗程。结果mFOLFOX6组和PF组的中位疾病无进展时间分别为8.5个月和6.3个月,有显著性差异,P〈0.05。1年总生存率分别为71%和67%,无显著性差异,P〉0.05,3年总生存率分别为32%和29%,无显著性差异,P〉0.05。mFOLFOX6组恶心呕吐发生率明显低于PF组,P〈0.05。mFOLFOX6组外周神经毒性发生率高于PF组,P〈0.05,但多数为Ⅰ～Ⅱ度。结论mFOLFOX6用于进展期胃癌术后辅助化疗,疾病无进展时间优于旧方案,毒性反应轻,胃癌术后患者容易接受。     

Role of postchemotherapy adjunctive surgery in the management of patients with nonseminoma arising from the mediastinum.

PURPOSE: To evaluate the role of postchemotherapy surgery in patients with nonseminomatous germ cell tumors arising from the anterior mediastinum. PATIENTS AND METHODS: Thirty-two patients with nonseminoma arising from a mediastinal primary site were treated on a clinical trial at our center, and they underwent postchemotherapy surgery. The results of postchemotherapy surgical resection, frequency of viable tumor found during postchemotherapy surgery, and prognostic factors for survival were assessed. RESULTS: Complete resection of all gross residual disease was achieved in 27 patients (84%). Histologic analysis of resected residua postchemotherapy revealed viable tumor in 66%, teratoma in 22%, and necrosis in 12% of the specimens. Viable tumor included embryonal carcinoma, choriocarcinoma, yolk sac carcinoma, seminoma, and teratoma with malignant transformation to nongerm cell histology (eg, sarcoma). Clinical characteristics associated with a shorter survival after surgery included the presence of viable tumor in a resected specimen (P =.003) and more than one site resected during surgery (P =.06). There were no statistically significant differences in survival for patients who underwent surgical resection with normal markers compared with patients with elevated serum tumor markers (P =.33). A trend toward shorter survival was found in patients with increasing tumor markers before surgery compared with patients with normal and declining serum tumor markers (P =.09). CONCLUSION: Surgical resection of residual mass after chemotherapy plays an integral role in the management of patients with primary mediastinal nonseminoma. Teratoma and viable tumor were found in the majority of resected residua after chemotherapy. Because patients who undergo conventional salvage chemotherapy programs rarely achieve long-term disease-free status, selected patients with elevated markers after chemotherapy are considered candidates for surgical resection.     

Shrinkage of locally advanced non-small-cell lung cancers in response to induction chemotherapy: implications for radiotherapy treatment planning

PURPOSE: To quantify the impact that changes in tumor volume after induction chemotherapy have on radiotherapy treatment planning for locally advanced non-small-cell lung cancer. METHODS AND MATERIALS: An analysis of coregistered pre- and postchemotherapy tumor volumes in a Phase II study of induction chemotherapy delivered before radical radiotherapy. RESULTS: Using the Response Evaluation Criteria In Solid Tumors measurement, 35% of patients had a partial response and 62% had stable disease after chemotherapy. Conversely, volumetric decreases in tumor size were seen in 95% of patients. Mean decreases in gross tumor volume and planning target volume were 37% and 26%, respectively. Using the smaller postchemotherapy tumor volume to plan radiotherapy treatment leads to a mean decrease in volume of lung receiving 20 Gy or greater of 3% (p < 0.005). Targeting the postchemotherapy volume also results in the delivery of a significant, although inhomogeneous, incidental dose of radiation to the rind of tissue formed around the shrinking tumor. Disease shrinkage is anisotropic, with greater displacements observed along anterior, posterior, and lateral margins. After chemotherapy, there is measurable blurring of the tumor's radiologic edge. CONCLUSIONS: Modest decreases in tumor volume that are not reflected by the Response Evaluation Criteria In Solid Tumors measurement occur in most patients. Although targeting the postchemotherapy tumor may decrease lung toxicity, the magnitude of the benefit is small. Because this strategy runs the risk of increasing the marginal recurrence rate, it should be used with caution. Quantification of tumor shrinkage and margin blurring permits more accurate reconstruction of the prechemotherapy target volume.     

Management of postchemotherapy residual mass in patients with advanced seminoma: Indiana University experience

Thirty-six patients with advanced seminoma treated with cisplatin combination chemotherapy were evaluated to assess the significance of postchemotherapy residual radiographic mass. All patients had a minimum follow-up of 2 years. Of the 36 patients 21 had an evaluable residual radiographic mass after completion of chemotherapy. Twelve of these patients had a less than 3 cm maximal transverse diameter residual mass, and nine had a greater than 3 cm persistent mass postchemotherapy. Only three of these 21 patients underwent postchemotherapy retroperitoneal lymph node dissection, and the histopathology revealed only necrotic fibrous tissue. The remaining patients were followed by close observation including repeat abdominal computed tomography (CT) every 3 months the first year and every 6 months the second year (or until normal); further therapeutic intervention was given only on evidence of progressive disease. Nineteen of these 21 patients have no evidence of disease, including eight of nine with greater than 3 cm persistent radiographic abnormality. The optimal management for advanced seminoma patients with a persistent radiographic mass postchemotherapy remains unresolved. However, based on this small series, we feel that observation is a viable option, reserving radiotherapy or chemotherapy for those patients who subsequently develop progressive disease.     

What are the indications for postchemotherapy retroperitoneal lymph node dissection?

Postchemotherapy retroperitoneal lymph node dissection (RPLND) is routinely performed if there is persistent >1 cm adenopathy. Some centers also recommend RPLND even in the presence of a normal postchemotherapy abdominal CT scan (nodes <1 cm). Our editorial provides little or no evidence to support performing a postchemotherapy RPLND if a complete remission is achieved with chemotherapy.     

Cytology of desmoplastic small round-cell tumor: comparison of pre- and post-chemotherapy fine-needle aspiration biopsies

BACKGROUND: Desmoplastic small round-cell tumor (DSRCT) is an aggressive malignancy of young adults, which is amenable to fine-needle aspiration biopsy (FNAB). As this entity is increasingly recognized and biopsied, cytopathologists are compelled to become familiar with the range of cytologic features of DSRCT. In addition, postchemotherapy tumors may be sampled to confirm disease recurrence before planning additional therapy. This study was designed to compare prechemotherapy and postchemotherapy cytomorphology of DSRCT and to evaluate for distinct chemotherapy-induced changes. METHODS: The authors searched their respective institutional databases for all DSRCT cases with an associated FNAB. FNAB slides, immunocytochemistry, and cytogenetic results were reviewed. RESULTS: Six aspirates from 5 patients were identified, 3 of which were postchemotherapy. The postchemotherapy cases demonstrated cytologic findings not typically described in DSRCTs, including prominent and conspicuous nucleoli, discohesive single-cell architecture, and slightly larger cell size. CONCLUSIONS: Cytomorphologic variability was prominent in prechemotherapy cases, and no case could be classified as DSRCT on cytology alone; immunohistochemistry was necessary for definitive diagnosis. Chemotherapy increased the spectrum of cytologic features. The most notable difference between the 2 groups was a predominantly discohesive single-cell pattern with conspicuous nucleoli in the postchemotherapy group, instead of the clustering pattern of medium-sized cells with inconspicuous nucleoli typically attributed to de novo cases reported in the literature.     

Cognitive and Psychological Factors Associated with Early Posttreatment Functional Outcomes in Breast Cancer Survivors

Breast cancer survivors experience cognitive difficulties following chemotherapy, yet the effects of these deficits on functional outcomes have not been systematically evaluated. This study assessed the relationships between postchemotherapy cognitive difficulties and functional outcomes. Forty-six women with breast cancer were seen at 1-month postchemotherapy; data were collected on cognitive functioning, psychological variables, and physical symptoms. Wilcoxon signed-rank analyses revealed cognitive deficits in executive functioning and verbal fluency. Subsequent regression analyses demonstrated that poorer executive functioning was associated with decreased productivity, community involvement, and social role functioning. Poorer quality of life was predicted by depression and reluctance to seek social support, but not cognitive functioning. These findings indicate that executive functioning deficits are associated with important functional outcomes among breast cancer survivors 1-month postchemotherapy. Thus, treatment efforts should focus on addressing cognitive, as well as psychological and physical, issues among cancer survivors.     

Cytology of desmoplastic small round‐cell tumor

BACKGROUND.

Desmoplastic small round‐cell tumor (DSRCT) is an aggressive malignancy of young adults, which is amenable to fine‐needle aspiration biopsy (FNAB). As this entity is increasingly recognized and biopsied, cytopathologists are compelled to become familiar with the range of cytologic features of DSRCT. In addition, postchemotherapy tumors may be sampled to confirm disease recurrence before planning additional therapy. This study was designed to compare prechemotherapy and postchemotherapy cytomorphology of DSRCT and to evaluate for distinct chemotherapy‐induced changes.

METHODS.

The authors searched their respective institutional databases for all DSRCT cases with an associated FNAB. FNAB slides, immunocytochemistry, and cytogenetic results were reviewed.

RESULTS.

Six aspirates from 5 patients were identified, 3 of which were postchemotherapy. The postchemotherapy cases demonstrated cytologic findings not typically described in DSRCTs, including prominent and conspicuous nucleoli, discohesive single‐cell architecture, and slightly larger cell size.

CONCLUSIONS.

Cytomorphologic variability was prominent in prechemotherapy cases, and no case could be classified as DSRCT on cytology alone; immunohistochemistry was necessary for definitive diagnosis. Chemotherapy increased the spectrum of cytologic features. The most notable difference between the 2 groups was a predominantly discohesive single‐cell pattern with conspicuous nucleoli in the postchemotherapy group, instead of the clustering pattern of medium‐sized cells with inconspicuous nucleoli typically attributed to de novo cases reported in the literature. Cancer (Cancer Cytopathol) 2006 © 2006 American Cancer Society.     

Use of 5-HT3 receptor antagonists to prevent nausea and emesis caused by chemotherapy for patients with breast carcinoma in community practice settings.

BACKGROUND: Although 5-HT3 receptor antagonists are clinically more effective in controlling emesis, particularly that caused by high dose cisplatin, than previously available agents, they appear to be less effective against nausea. This report focuses on the effectiveness of these agents against nausea and emesis in patients receiving two moderately emetogenic combination chemotherapy regimens as treatment for breast carcinoma in community practice settings. METHODS: Six hundred ninety-two breast carcinoma patients (688 female, 4 male; mean age, 51 years) enrolled in a nonrandomized study completed the Morrow Assessment of Nausea and Emesis (MANE) following 4 consecutive chemotherapy treatments. The frequency, duration, and severity of postchemotherapy nausea (PN) and postchemotherapy emesis (PE) were compared by type of antiemetic (5-HT3 receptor antagonist vs. other) and chemotherapy regimen (cyclophosphamide and doxorubicin with or without 5-fluorouracil [CA/CAF] vs. cyclophosphamide, methrotrexate, and 5-fluorouracil [CMF]). RESULTS: Within each regimen, the mean duration of PN was significantly longer for patients who received a 5-HT3 receptor antagonist than for those who were not given an antiemetic of that type (CA: 40.3 hours vs. 29.6 hours, P < 0.05; CMF: 37.6 hours vs. 30.2 hours, P < 0.05). There were no significant differences in the frequency or severity of nausea or in the frequency, severity, or duration of emesis by type of antiemetic for patients receiving either regimen. CONCLUSIONS: The results of this observational study suggest that 5-HT3 receptor antagonists are no more effective than other commonly used medications in controlling postchemotherapy nausea and emesis in women with breast carcinoma who are treated with moderately emetogenic chemotherapy in community practice settings. In fact, they may be associated with significant prolongation of the course of postchemotherapy nausea.     

Outcome of postchemotherapy surgery after treatment with methotrexate, vinblastine, doxorubicin, and cisplatin in patients with unresectable or metastatic transitional cell carcinoma.

PURPOSE: The role of postchemotherapy surgery for patients with metastatic transitional cell carcinoma (TCC) is controversial. We retrospectively analyzed our experience with patients who underwent postchemotherapy surgery after methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC) chemotherapy to assess an impact on long-term survival. PATIENTS AND METHODS: This report is based on the retrospective analysis of 203 patients with unresectable primary tumors or metastatic TCC, previously reported in five trials of M-VAC chemotherapy. Fifty patients underwent postchemotherapy surgery for suspected or known residual disease. Characteristics of patients selected for surgery, results of surgery, and the impact of surgery on survival were assessed. RESULTS: In 17 patients, no viable tumor was found at postchemotherapy surgery, pathologically confirming a complete response to chemotherapy. Three patients had unresectable residual TCC. In 30 patients, residual, viable TCC was completely resected, which resulted in a complete response to chemotherapy plus surgery. Ten (33%) of these 30 patients remained alive at 5 years, similar to results observed for patients who attained a complete response to chemotherapy alone (41%). Analysis by baseline extent of disease suggested that patients with unresectable primary tumors or with metastases restricted to lymph node sites were most likely to survive for 5 years. CONCLUSION: Postchemotherapy surgical resection of residual cancer may result in 5-year disease-free survival in some patients who would otherwise succumb to disease. Optimal candidates include patients whose prechemotherapy sites of disease are restricted to the primary or lymph node sites and who have a major response to chemotherapy.     

Variables contributing to anticipatory nausea and vomiting in cancer chemotherapy.

Forty cancer patients receiving parenteral chemotherapy were assessed for characteristics associated with the development of anticipatory nausea and vomiting (ANV). The patients who developed ANV were more likely to have increased pretreatment anxiety (p less than 0.05), greater posttreatment dizziness/lightheadedness (p less than 0.01), more severe postchemotherapy vomiting (p less than 0.01), and a delayed onset of postchemotherapy nausea and vomiting (PCNV) compared to the patients who developed neither ANV nor PCNV. However, when patients who did not develop PCNV were excluded from the analysis, the difference between the ANV and non-ANV patients remained significant only for postchemotherapy dizziness/lightheadedness (p less than 0.05). In an attempt to identify a group of variables that better predict the development of ANV, we analyzed the data for combinations of variables. Two indices were found to correctly classify ANV and non-ANV patients 71% of the time (p less than 0.05). Index A refers to the presence of at least two of the following variables, pretreatment anxiety, posttreatment dizziness/lightheadedness, and latency of PCNV. Index B refers to the presence of at least two of the following variables: pretreatment anxiety, severity of nausea, and severity of vomiting. The identification of characteristics associated with the development of ANV could lead to new intervention strategies.