原发性肝癌合并门脉癌栓的治疗

目的 观察６１例原发性肝癌合并门脉癌栓患者的治疗效果。方法 Ａ组（３６例）行肝动脉化疗栓塞（ＴＡＣＥ）治疗,Ｂ组（２５例）行ＴＡＣＥ结合外放射综合治疗,两组一般临床资料无显著差异（Ｐ〉０．０５）。结果 Ａ组１、２年生存率分别为２２．３％、４．５％,平均生存期７．５个月;Ｂ组１、２、３年生存率分别为３９．２％、２１．２％、１７．２％,平均生存期１３．５个月,两组差异有显著性（Ｐ〈０．０５）。结论 对     

动脉灌注化疗并同期放疗的综合治疗中晚期胰腺癌

目的观察动脉灌注化疗并同期放疗的综合治疗中晚期胰腺癌的作用。方法９２年１月至９６年１月收治５２例中晚期胰腺癌,２３例行动脉灌注化疗并同期放疗（综合组）,２９例行单纯放疗（单放组）。单放组每周照５次,每次１８０－２００ｃＧＹ,总量５０００－６０００ｃＧＹ／５－６．７周,综合组动脉灌注化疗,每次５－Ｆｕ１．０、ＭＭＣ１０ｍｇ、ＤＤＰ６０ｍｇ,每４周一次,平均２．３次／人,同期放疗方案同单放组。结果腹痛、黄疸的症状缓解率两组之间无明显差异,但综合组黄疸改善时间较长（１３个月对５个月Ｐ＜０．０５）;肿瘤缩小率达５０％以上综合组６９．６％（１６／２３）,单放组３７．９％（１１／２９）;两组１、２、３年生存率分别为７８．５％、３７．１％、２６．７％和５２．３％、２２．９％、１０．５％,综合组明显好于单放组。结论不能手术切除的中晚期胰腺癌通过动脉灌注化疗并同期放射治疗的综合治疗较单放组能获得较高的生存率。     

原发性肝癌经腹肝动脉栓塞化疗与姑息性切除术的疗效比较

本文对３２例原发性肝癌经腹肝动脉插管，使用碘油抗癌药物乳化液栓塞治疗，与４８例原发性肝癌行姑息性切除术进行比较分析。结果：栓塞化疗组与姑切组的ＡＦＰ转阴率、１年生存率、２年生存率分别为：８２．７％（２４／２９）与０，６２．５％（２０／３２）与２０．１％（１０／４８），３２．０％（８／２５）与０（Ｐ＜０．０５）。且栓塞化疗组３例获Ⅱ期根治性切除术．１例带瘤生存５４个月，至今健在。提示：对不能行根治性切除的肝癌，选用肝动脉插管栓塞化疗为佳。     

化放疗,放疗和化疗治疗肺癌脑转移的疗效评价

目的 评价化放疗,放疗和化疗治疗肺癌脑转移的疗效。方法 化疗加放疗３２例,放疗１９例,化疗１１例,结果 化放疗组,放疗组和化疗组的中位生存期分别为６．９月,５．８月,３．６月;１年生存率分别为２８．１％,２１．１％,０％,经疗组的疗效虽稍优于放疗组,但在统计学上差异无显著性（Ｐ〉０．０５）。而化疗疗组及放疗组明显好于化疗组（Ｐ〈０．０５）。结论 化放疗及放疗特别是化放疗是治疗肺癌脑转移的有效治疗方     

MNP与MVP方案治疗晚期非小细胞肺癌的疗效比较

目的：比较ＭＮＰ方案（丝裂霉素、去甲长春碱、顺铂）与ＭＶＰ方案（丝裂霉素、长春地辛、顺铂）治疗晚期非小细胞肺癌的疗效。方法：８３例晚期非小细胞肺癌患者接受ＭＮＰ与ＭＶＰ方案化疗。病人一般特征经χ＾２检验和ｔ检验,两组具有可比性（Ｐ〉０．０５）。ＭＮＰ方案４０例,ＭＶＰ方案４３例。结果：ＭＮＰ组ＣＲ３例,ＰＲ１５例,ＮＣ２０例,ＰＤ２例,有效率为４５．０％;中位缓解期８．０月,中位生存期１０．５月,１年生存率４２．５％。ＭＰＶ组ＰＲ１４例,ＮＣ２０例,ＰＤ９例,有效率为３２．６％;中位缓解期６．８月,中位生存期８．１月,１年生存率２７．９％。两组有效率无显著性差异（Ｐ＝０．０６９７５,Ｒａｄｉｔ分析）,ＭＮＰ组生存期优于ＭＰＶ组,但无统计学差异（Ｐ＝０．１５１６,Ｌｏｇ－ｒａｎｋ检验）。血液学毒性发生率ＭＮＰ组高     

多结节性肝癌的治疗探讨

总结２９２例多结节性肝癌的治疗。全身化疗１１１例，肝动脉栓塞化疗５８例，多次局切６７例，局切后并用肝动脉、门静脉插管化疗５６例。结果：ＡＦＰ转阴率分别为０、３８．１％、７４．５％、８４．６％；各组１、２、３、５年生存率分别为１８．２％、４５．６％、５２．２％、５３．８％；１．９％、３８．９％、２５．８％、５０．９％；０、７．５％、２０．３％、４６．３％；０、１．９％、５．２％、１７．３％。提示，多结节性肝癌手术切除优于药物治疗，切除后并用肝动脉、门静脉插管化疗优于单纯局切，非手术治疗者。碘油抗癌药物乳化液栓塞治疗优于全身化疗（Ｐ均＜０．０５）。     

CD3AK对晚期肝癌疗效初步观察

目的观察晚期肝细胞癌（ＨＣＣ）患者采用抗ＣＤ３抗体激活的杀伤细胞（ＣＤ３ＡＫ）治疗的效果。方法５８例晚期ＨＣＣ患者分为三组，Ａ组［ＣＤ３ＡＫ＋肝动脉化学栓塞（ＴＡＣＥ）］２２例，Ｂ组（ＣＤ３ＡＫ）１５例，Ｃ组（ＴＡＣＥ）２１例。结果部分缓解率（ＰＲ）Ａ，Ｂ，Ｃ组分别为４５．５％、１３．３％（Ｐ＜０．０５）和１４．３％（Ｐ＜０．０５），中位生存期分别为１１．３月、４．９月（Ｐ＜０．０１）和４．１月（Ｐ＜０．０１），半年和１年生存率分别依次为６８．２％，３３．３％（Ｐ＜０．０５）和２３．８％以及４０．９％、６．６％（Ｐ＜０．０５）和９．５％（Ｐ＜０．０５）。结论本组结果表明ＣＤ３ＡＫ＋ＴＡＣＥ治疗晚期ＨＣＣ疗效最佳     

经皮经股动脉植入药盒治疗晚期原发性肝癌的临床疗效

目的探讨药盒在晚期原发性肝癌治疗中的临床价值。方法无外科手术及动脉栓塞指征的８２例晚期原发性肝癌,依据动脉内化疗方式不同,分为两组：Ａ组４２例,采取经皮经股动脉植入药盒,术后经药盒１周或２周化疗１次;Ｂ组４０例,采取每个月１次插管大剂量化疗。结果Ａ、Ｂ两组有效率（ＣＲ＋ＰＲ）分别为３８．１％和１５．０％（Ｐ＜０．０５）。Ａ组６个月、１年、２年生存率分别为６１．９％、２８．６％、９．５％;Ｂ组分别为２０％、５％、０％（Ｐ＜０．０１）。Ａ组患者的生存质量明显改善,消化道反应、肝、胆、骨髓毒性均较Ｂ组低。结论经药盒间断性化疗并配合地塞米松治疗晚期原发性肝癌可明显改善患者的生存质量,提高生存率。     

肿瘤介入治疗中动脉应用5-HT_3受体拮抗剂价值的探讨

目的：探讨恶性肿瘤介入治疗中动脉应用５－ＨＴ３受体拮抗剂对防治胃肠道副作用的价值。方法：采用随机对照研究,分为治疗组（ｎ＝１２０）和对照组（ｎ＝４０）,治疗组再分为欧必亭组（ｎ＝６０）和非欧必亭组（ｎ＝６０）,其中 ３０例为自身对照。治疗组术中化疗／栓塞前 １５分钟（ｎ＝６０）或后即刻（ｎ＝６０）于动脉内推注 ５－ＨＴ３受体拮抗剂,对照组术中来用 ５－ＨＴ３受体拮抗剂。主要采用 ５－ＦＵ、ＤＤＰ、ＭＭＣ、ＴＨＰ或 ＡＤＭ大剂量联合灌注化疗方案。结果：介入治疗术中急性胃肠道反应发生率为１４．４％（２３／１６０）,其中治疗组为１４．２％（１７／１２０）,对照组为１５． ０％（６／４０）,两组差异无显著意义（Ｐ＞０．０５）;但５－ＨＴ３受体拮抗剂介入化疗／栓塞前应用组明显优于化疗／栓塞后应用组（Ｐ＜０．０５）。出现胃肠道反应后立即停止操作,治疗组仍动脉内推注５－ＨＴ３受体拮抗剂。症状缓解率对照组为６６．６％（４／６）,治疗组达 １００％;两组差异有显著意义（Ｐ＜０,０５）。术后 １２小时、１天和３天胃肠道反应发生率对照组分别为４７．５％（１９／４０）、４５％（１８／４０）和３７．５％（１５／４０）,治疗组分别为１．６％（２     

转移性肝癌外放射肝动脉化疗栓塞综合治疗

目的探讨转移性肝癌的外放射、肝动脉化辣栓塞的综合治疗价值。方法回顾性分析转移肝癌的肝动脉化疗栓塞、外放射综合治疗及单纯外放射治疗的治疗效果。综合治疗组的有效率为５３．６％，１年、２年、３年生存率分别为６０．７％、３２．２％、１４．３％、单纯放疗组的有效率为３２％、１年、２年、３年经分别为４４．０％、２８．０％、１２．０％。综合治疗组、单纯放疗组的平均生存期分别为１４．６个月、１１．８个月。其中Ⅲ期     

Experience with Impedance Phlebography Compared with Venography

Venography is a particularly reliable method for the diagnosis of deep venous thrombosis but is not suitable as a screening test. Impedance phlebography represents another attempt to discover a simple, non-invasive and reliable method of detecting deep venous thrombosis. It does not, however, meet these criteria.     

Compliance with guidelines and correlation with outcome in patients with advanced germ-cell tumours

PurposeTo evaluate prior compliance with guidelines in patients treated with salvage chemotherapy for advanced germ-cell tumours (GCT).Patients and methodsData concerning the initial management of patients requiring salvage chemotherapy for GCT at Institut Gustave Roussy between 2000 and 2010 were obtained and correlated with recommendations for treatment. Criteria of non-compliance were defined based on guidelines. Compliance with guidelines, predictive factors for non-compliance and the impact on outcome were analysed.ResultsAmong 82 patients treated in the salvage setting, guidelines to initial treatment were followed in only 41 cases (50%). The most common non-compliance criteria were non-adherence to the planned dose (16%), an inappropriate interval between first-line chemotherapy cycles (16%), the lack of post-chemotherapy surgery (16%) and a long interval to post-chemotherapy surgery (48%). Compliance with standard care was better in cancer centres than in other hospitals (private or public) (Odd Ratio (OR): 6.9, P = 0.001). A poor-risk status according to the International Germ Cell Cancer Collaborative Group (IGCCCG) was also predictive of compliance in univariate but not in multivariate analysis. No significant difference in outcome after salvage chemotherapy was observed. Patients relapsing after non-compliant first-line therapy tended to be more easily salvaged, which is consistent with the fact that their initial treatment was inadequate. Some of these relapses were therefore probably not due to true biologically refractory disease.ConclusionGuidelines for first-line treatment are adhered to in only half the patients requiring salvage chemotherapy. As the only predictive factor for non-compliance was the treating centre, centralisation of patients with GCT in well-trained hospitals should be recommended.     

Treatment with methylnaltrexone is associated with increased survival in patients with advanced cancer

BackgroundMethylnaltrexone (MNTX), a peripherally acting μ-opioid receptor (MOR) antagonist, is FDA-approved for treatment of opioid-induced constipation (OIC). Preclinical data suggest that MOR activation can play a role in cancer progression and can be a target for anticancer therapy.Patients and methodsPooled data from advanced end-stage cancer patients with OIC, despite laxatives, treated in two randomized (phase III and IV), placebo-controlled trials with MNTX were analyzed for overall survival (OS) in an unplanned post hoc analysis. MNTX or placebo was given subcutaneously during the double-blinded phase, which was followed by the open-label phase, allowing MNTX treatment irrespective of initial randomization.ResultsIn two randomized, controlled trials, 229 cancer patients were randomized to MNTX (117, 51%) or placebo (112, 49%). Distribution of patients' characteristics and major tumor types did not significantly differ between arms. Treatment with MNTX compared with placebo [76 days, 95% confidence interval (CI) 43–109 versus 56 days, 95% CI 43–69; P = 0.033] and response (laxation) to treatment compared with no response (118 days, 95% CI 59–177 versus 55 days, 95% CI 40–70; P < 0.001) had a longer median OS, despite 56 (50%) of 112 patients ultimately crossing over from placebo to MNTX. Multivariable analysis demonstrated that response to therapy [hazard ratio (HR) 0.47, 95% CI 0.29–0.76; P = 0.002) and albumin ≥3.5 (HR 0.46, 95% CI 0.30–0.69; P < 0.001) were independent prognostic factors for increased OS. Of interest, there was no difference in OS between MNTX and placebo in 134 patients with advanced illness other than cancer treated in these randomized studies (P = 0.88).ConclusionThis unplanned post hoc analysis of two randomized trials demonstrates that treatment with MNTX and, even more so, response to MNTX are associated with increased OS, which supports the preclinical hypothesis that MOR can play a role in cancer progression. Targeting MOR with MNTX warrants further investigation in cancer therapy.Clinical trials numberNCT00401362, NCT00672477.     

Sarcopenia is associated with survival in patients with urothelial carcinoma treated with systemic chemotherapy

International Journal of Clinical Oncology - Sarcopenia impacts perioperative outcomes and prognosis in various carcinomas. We aimed to investigate whether sarcopenia at the time of chemotherapy...     

Costs associated with complications are lower with capecitabine than with 5‐fluorouracil in patients with colorectal cancer

BACKGROUND:

Capecitabine, an oral alternative to 5‐fluorouracil (5‐FU) in patients with colorectal cancer (CRC), has equal clinical efficacy and a favorable safety profile; however, its use may be limited because of unit cost concerns. In this study, the authors measured the cost of chemotherapy‐related complications during treatment with capecitabine‐ and 5‐FU–based regimens.

METHODS:

Patients with CRC who received at least 1 administration of capecitabine or 5‐FU during 2004 and 2005 were identified from the Thomson MarketScan research databases. Monthly frequency and cost for 23 complications were recorded. Logistic regression was used to predict complication probability. General linear models were used to predict monthly complication cost and total monthly expenditure.

RESULTS:

In total, 4973 patients with CRC met the inclusion criteria for this analysis. Although the most frequently observed complications were the same between capecitabine and 5‐FU (nausea and vomiting, infection, anemia, neutropenia, diarrhea), each was observed with greater frequency in 5‐FU–based regimens. The mean predicted monthly complication cost was significantly higher (by 136%) with 5‐FU monotherapy than with capecitabine monotherapy (difference, $601; 95% confidence interval [95% CI], $469‐$737). In addition, the mean predicted monthly complication cost for 5‐FU+oxaliplatin was higher than the cost with capecitabine plus oxaliplatin (difference, $1165; 95% CI, $892‐$1595). When acquisition, administration, and complication costs were taken into consideration, there were no significant differences in the total cost between capecitabine regimens and 5‐FU regimens.

CONCLUSIONS:

Capecitabine compared well with 5‐FU–based therapy in patients with CRC and was associated with lower complication rates and associated costs. Cancer 2009. © 2009 American Cancer Society.     

超声心动图诊断26例心脏黏液瘤

应用经胸二维超声心动图（2DE）、彩色血流显像（CDFI）及频谱多普勒显像（Doppler）诊断26例心脏黏液瘤（27个瘤体）,对团块的位置、数目、大小、形状、瘤蒂附着点和活动度、心腔内及瓣膜口血流等进行探查及分析．认为心脏超声检查是心脏黏液瘤的首选检查方法,具有实时、经济、简便易行等优点。     

Living with secondary breast cancer: coping with an uncertain future with unmet needs

JOHNSTON S.R.D. (2010) European Journal of Cancer Care 19 , 561–563 Living with secondary breast cancer: coping with an uncertain future with unmet needs