XELOX方案新辅助化疗治疗局部进展期胃癌的临床研究

目的观察XELOX方案新辅助化疗治疗局部进展期胃癌的临床疗效。方法 86例进展期胃癌患者随机分为两组,观察组49例采用XELOX方案新辅助化疗治疗,对照组37例采用FOLFOX4方案新辅助化疗治疗,对比观察两组的临床疗效及不良反应情况。结果观察组总有效率为53.1%,略高于对照组的43.2%,但两组比较差异无统计学意义(P>0.05)。观察组恶心呕吐、粒细胞减少、乏力和贫血发生率明显低于对照组(P<0.05),两组外周神经毒性发生率比较,差异无统计学意义(P>0.05)。结论 XELOX方案新辅助化疗治疗局部进展期胃癌疗效确切,不良反应少,是一种良好的新辅助化疗方案。     

超分割调强同步放化疗及辅助化疗治疗老年局部晚期食管癌的临床观察

目的 观察超分割调强适形放疗同步奈达铂化疗+辅助化疗综合治疗老年局部晚期食管癌的近期疗效及不良反应。方法 回顾性分析52例局部晚期老年食管癌患者资料,观察组30例给予调强适形超分割放疗（64.4~75.9 Gy/56~66 F, 1.15 Gy/F, 2次/日, 每周5次）和奈达铂25~30 mg/m2同步化疗,卡培他滨辅助化疗（每天2 000~2 500 mg/m²）4~6周期。对照组22例给予常规分割调强适形放疗（52~60 Gy/26~30 F, 2 Gy/F, 1次/日, 每周5次）及奈达铂同步化疗及卡培他滨辅助化疗。结果 观察组28例（93%）患者经过同步放化疗后1月内吞咽梗阻缓解,中位生存时间29月,1、2、3年生存率87%、66%、25%。对照组16例（72%）放疗结束一月内吞咽梗阻缓解,中位生存期时间26月,1~3年生存率分别为83%、61%、22%。两组生存率差异无统计学意义（P=0.19）,观察组和对照组无疾病进展中位生存时间分别为25月、20月,无疾病进展生存率差异有统计学意义（P=0.041）。不良反应两组差异无统计学意义。结论 超分割精确放疗和同步化疗及单药卡培他滨辅助化疗与常规分割调强放疗比较,未明显增加不良反应,有助于改善局部晚期老年食管癌早期梗阻症状和无疾病进展生存时间。     

Doses in organs at risk during head and neck radiotherapy using IMRT and 3D-CRT

Background.

Treatment planning for head and neck (H&N) cancer is complex due to the number of organs at risk (OAR) located near the planning treatment volume (PTV). Distant OAR must also be taken into consideration. Intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3D-CRT) are both common H&N treatment techniques with very different planning approaches. Although IMRT allows a better dose conformity in PTV, there is much less evidence as to which technique less dose to OAR is delivered. Therefore, the aim of the study was to compare IMRT to 3D-CRT treatment in terms of dose distribution to OAR in H&N cancer.

Patients and methods.

This was a prospective study of a series of 25 patients diagnosed with stage cT_3–4N_0–2 laryngeal cancer. All patients underwent total laryngectomy and bilateral selective neck dissections. In all cases, patients were treated with IMRT, although a 3D-CRT treatment plan was also developed for the comparative analysis. To compare doses to specific OAR, we developed a new comparative index based on sub-volumes.

Results.

In general, IMRT appears to deliver comparable or greater doses to OAR, although the only significant differences were found in the cerebellum, in which 3D-CRT was found to better spare the organ.

Conclusions.

Organs located outside of the IMRT beam (i.e., distant organs) are generally thought to be well-spared. However, the results of this study show that, in the case of the cerebellum, this was not true. This finding suggests that larger studies should be performed to understand the effects of IMRT on distant tissues. Anthropomorphic phantom studies could also confirm these results.     

老年食管癌三维适形与调强放射治疗疗效比较

目的比较老年食管癌三维适形放射治疗(3D-CRT)或调强放疗(IMRT)的疗效及其预后相关因素。方法回顾性分析153例65岁以上老年食管癌患者的临床资料,105例行3D-CRT、48例行IMRT,采用SPSS11.5统计软件比较分析生存率及预后影响因素。结果放疗后食管造影评价CR 71例、PR 78例、NR 4例,总有效率(CR+PR)为97.4%;全组1、3年生存率和局部控制率分别为70.6%、34.2%和76.2%、51.1%。3D-CRT与IMRT组资料相比,IMRT组胸中下段及淋巴结转移者较多、CT食管肿瘤最大径较大、放疗剂量更高、联合化疗者更多(P<0.05);而性别、年龄、T分期、放疗前进食情况及食管造影长度两组间比较差异无统计学意义(P>0.05)。3D-CRT与IMRT组1、3年生存率和局部控制率比较,差异无统计学意义(P>0.05),分层分析中两组生存率比较,差异无统计学意义(P>0.05)。全组单因素分析显示,治疗前进食情况、病变部位、T分期、淋巴结转移与否、食管造影显示病变长度、CT肿瘤最大直径、化疗和近期疗效与预后生存有关(P<0.05);Cox多因素分析仅化疗和CT肿瘤最大直径为独立预后因素(P<0.05)。结论老年食管癌IMRT与3D-CRT比较无明显生存优势,联合化疗及肿瘤最大直径小者放疗疗效较好,但需进一步前瞻性研究。     

胃癌根治术后切端癌残留的预后及化学治疗效果

目的了解胃癌根治术后切端癌残留对预后的影响及术后化疗是否能提高其生存率.方法对70例胃癌根治术后切端癌残留病例及1073例无癌残留病例回顾性分析及随访结果.结果远侧胃大部切除术后切端阳性与切端阴性者总5年生存率分别为12.5%、38.2%(P＜0.05),近端胃大部切除术后切端阳性与切端阴性5年生存率分别为13.0%、25.5%(P＜0.05).但按分期比较,则各期5年生存率切端阳性与切端阴性均无显著性差异(P＞0.05).而术后化疗者5年生存率为20.0%,未化疗者为0,二者有显著性差异(P＜0.05)     

XELOX替代OFL完成12例胃结肠癌化疗报道

目的 完成因OFL(奥沙利铂 CF 5-Fu)毒副反应而无法进行下去的13例胃癌或结肠癌患者的术后6周期辅助化疗.方法 OFL方案治疗过程中,因出现严重的化疗毒副反应,预计无法完成6周期术后辅助化疗,改用XELOX(奥沙利铂 卡培他滨)方案化疗.结果 12例顺利完成剩余周期化疗,未产生严重毒副反应.结论 对无法耐受OFL方案化疗的胃癌或结肠癌患者,XELOX方案是一种可行的选择.     

乳腺癌保乳术后行IMRT和3D-CRT治疗的剂量学参数及靶区适形度比较

目的:通过配对比较早期乳腺癌保乳术后IMRT和3 D-CRT两种放疗技术模式下靶区的适形度和肺组织的受照体积-剂量参数,探索早期乳腺癌保乳术后的最佳放疗模式.方法:选取20例I-II期(T1-2 N0M0)乳腺癌保乳术后行全乳腺放疗者,对同一患者分别设计IMRT和3D-CRT两套放射计划方案,配对分析PTV及PGTVb...     

Efficacy and Tolerability of Adjuvant Oral Capecitabine plus Intravenous Oxaliplatin (XELOX) in Asian Patients with Colorectal Cancer: 4-Year Analysis

Background: Although FOLFOX (infusional fluorouracil/leucovorin plus oxaliplatin) is established asa standard chemotherapeutic regimen, the long term efficacy of adjuvant XELOX (oral capecitabine plusintravenous oxaliplatin) in Asian colorectal cancer (CRC) patients remains anecdotal. Moreover, uncertaintiespersist as to whether pharmacogenetic differences in Asian populations preclude equally tolerable and effectiveadministration of these drugs. Method: One hundred consecutive patients with resected colorectal cancerreceived adjuvant XELOX (oxaliplatin 130 mg/m2 on day 1 plus capecitabine 900 mg/m2 twice daily on day 1 to14 every 3 weeks for 8 cycles) at Queen Mary Hospital, Hong Kong. Endpoints monitored during follow-up weredisease-free survival (DFS) and disease recurrence, overall survival (OS) and adverse events (AEs). Results: Themedian patient age was 56 years, 56% were diagnosed with rectal cancer and 44% with colonic cancer. After amedian follow-up of 4.3 years (95% confidence interval, 3.2-4.7), 24 recurrences were confirmed including 13patients who died due to progressive disease. Four-year DFS was 81% in colon cancer patients and 67% in rectalcancer patients (p=0.06 by log-rank test). For the cohort as a whole, OS was 90% at 3 years and 84% at 5 years.Treatment-related AEs led to early withdrawal in four patients. The commonest non-hematological AEs wereneuropathy (91%), hand-foot syndrome (49%) and diarrhea (46%), while the commonest grade 3/4 AEs wereneutropenia (11%) and diarrhea (10%). Conclusion: These results confirm the favourable long term survivalbenefit with good tolerability in using adjuvant XELOX in treating East Asian colorectal cancer patients.     

XELOX方案与SOX方案在胃癌新辅助治疗中的应用价值

目的 探讨XELOX(卡培他滨+奥沙利铂)方案和SOX(替吉奥胶囊+奥沙利铂)方案治疗晚期胃癌的效果.方法 晚期胃癌患者60例,随机平均分为2组:XELOX治疗组和SOX治疗组.2组均以21天为1个疗程,完成2个疗程治疗评定疗效,并随访观察2组疾病进展时间及生存时间.结果 XELOX方案与SOX方案的总有效率分别为36.67％和46.67％,疾病控制率分别为80.00％和86.67％.2组不良反应发生率比较,差异无统计学意义(P＞0.05).结论 XELOX方案和SOX方案治疗晚期胃癌,临床疗效和安全性相近,且容易被患者耐受,可以作为晚期胃癌患者的有效治疗方案.     

Adjuvant Treatment for Gastric Cancer: Chemotherapy Versus Radiation

Gastric cancer is among the leading causes of cancer death worldwide. Surgery is the only curative modality, but mortality remains high because a significant number of patients have recurrence after complete surgical resection. Chemotherapy, radiation, and chemoradiotherapy have all been studied in an attempt to reduce the risk for relapse and improve survival. There is no globally accepted standard of care for resectable gastric cancer, and treatment strategies vary across the world. Postoperative chemoradiation with 5‐fluorouracil/leucovorin is most commonly practiced in the United States; however, recent clinical trials from Asia have shown benefit of adjuvant chemotherapy alone and have questioned the role of radiation. In this review, we examine the current literature on adjuvant treatment of gastric cancer and discuss the roles of radiation and chemotherapy, particularly in light of these new data and their applicability to the Western population. We highlight some of the ongoing and planned clinical trials in resectable gastric cancer and identify future directions as well as areas where further research is needed.     

非小细胞肺癌三维适形放射治疗对食管损伤的临床和剂量学预测因素

目的:分析非小细胞肺癌(NSCLC)在三维适形放射治疗(3D-CRT)时,放射所致3～5级(RTOG标准)食管损伤的临床和剂量学的预测因素.方法:对连续的208例三维适形放射治疗的非小细胞肺癌患者,男146例,女62例,中位年龄64岁(35～87岁)进行了回顾性分析.分析对象为:性别,年龄,一般状态,序贯化疗,同期化疗,隆突下淋巴结,治疗前体重下降,整个食管平均剂量,最大剂量点,食管接受＞55Gy的百分比.依据RTOG标准,分析早期和晚期3～5级食管损伤.结果:208例中,25例(12%)发展为早期和晚期3～5级的食管损伤,其中9例包括早期和晚期损伤,2例死于食管穿孔.同期化疗和食管的最大剂量点≥60Gy与3～5级食管损伤明显有关.其中同期化疗的54例(26%),25例(46%)有3～5级食管损伤.最大剂量点小于60Gy的患者,无3～5级食管损伤(P＜0.01)发生.结论:在NSCLC三维适形放疗时,放化疗同期进行和最大剂量点≥60Gy明显地与3～5级食管损伤有关.     

单发脑转移性癌IMRT与3D-CRT剂量学对比分析

目的 探讨调强放疗(IMRT)用于单发脑转移性癌治疗的可行性,并评价其相较于三维适形放疗(3D-CRT)是否具有剂量学优势.方法 取10例单发脑转移性癌患者行体位固定、CT扫描及靶区勾画,分别对每例患者行三维适形放疗(全脑2野对穿+3野局部加量)及5野调强放疗(IMRT)计划设计,分析两种放疗计划的剂量体积直方图,比较两种放疗计划的靶区适形度、均匀指数,靶区剂量、靶区覆盖情况及各个危及器官的受照射剂量.结果 IMRT计划与3D-CRT计划相比显著提高了PTV-G和PTV-C的适形指数(P＜0.05),而在靶区均匀指数(HI)方面,IMRT计划与3D-CRT计划未表现出统计学差异(P＞0.05).对于危及器官,IMRT计划显著降低了脑干、视交叉和脑垂体的最大受照射剂量(P＜0.05).结论 对于单发脑转移性癌,IMRT和3D-CRT两种计划均能满足合适的靶区覆盖率,均能达到放射治疗的要求,IMRT计划相对于3D-CRT计划有更好的靶区适形性.IMRT计划还可以降低脑干、视交叉和脑垂体的受照射剂量.     

Long-Term Outcome of A Large Series of Gastric Cancer Patients in China

Objective:The outcome of gastric cancer treatment in China is relatively poor compared with those in Japan and Korea.Relevant factors are not quite clear till now.The aim of this study is to present data on gastric cancer patients from a single high volume cancer center of China and to illuminate relevant factors regarding unsatisfactory outcome.Methods:A total of 2312 consecutive pathologically proven gastric carcinoma patients were treated in Beijing Cancer Hospital from January 1995 to December 2005.Clin...     

高龄胃癌的外科治疗

 目的　总结分析高龄胃癌的临床病理学特征 ,来指导临床治疗。方法　对我院 1975～ 1993年间收治的 4 5例高龄胃癌进行回顾分析。结果　高龄胃癌男性多发 ,男女比例为 8∶1;首发症状不典型 ,病程长 (平均 1 5年 ) ,均为进展期胃癌 ;大多数病例术前伴发冠心病、高血压、糖尿病、慢性肺心病 ;发病部位以胃远端为主 ,肿块直径多数大于 5厘米 ,侵出浆膜者占 31 1%,淋巴转移率为 71 1%;组织学类型 ,分化好的占多数 ( 55 6%) ;手术切除率为 88 9%,根治性切除率55 6%。 3年生存率为 2 6 2 %,5年生存率为 17 8%。结论　为提高该类患者的预后 ,早期发现、早期诊断、早期治疗、做好病人术前伴发症的纠正及加强术后护理是关键。     

Chinese Patients with Gastric Cancer Need Targeted Adjuvant Chemotherapy Schemes

Background: Gastric cancer (GC) is one of the most common cancers in China. Adjuvant chemotherapy(AC) is a routine auxiliary treatment for GC recommended by the guidelines issued in 2011 by the Ministry ofHealth of the People’s Republic of China, but the relevant credible consequences in China have been insufficientbecause of China’s late start and ethical concerns. Methods: A series of databases, including Cochrane Library,MEDLINE, EMBASE, the Chinese database of the National Knowledge Infrastructure and the VIP database,were searched by 2 reviewers independently for studies investigating AC for GC through March 2012. Theretrieved literature was screened according to the eligibility criteria. Results: A total of 35 randomized controltrials (RCTs) were subjected to the final analysis, including 4,043 patients in treatment group and 3,884 inthe control group, as well as 4 clinical-control trials (CCTs), which accessed the final analysis with 238 and252 patients, respectively. AC reduced the risk of death as a protective treatment with statistical significance(HR=0.91, 95%CI: [0.85, 0.97], P=0.002), and it seemed more effective for Asian than non-Asian patients. Theeffects of AC were not influenced by the starting time (P>0.05). D2 lymphadenectomy-based chemotherapywas effective (HR=0.89, 95%CI: [0.80, 0.99], P=0.04). Oral S-1 40 mg/m2 after D2 lymphadenectomy mightbe a better choice for Asians with advanced GC and might result in a greater reduction of adverse events thanin non-Asian patients. GRADE quality assessment determined that the strength of the evidence from foreignstudies from Europe, the United States and Asian countries other than China was high, while it was moderatefor Chinese studies. Conclusion: AC was effective or even curative in Chinese patients in general, although it isstill necessary to optimize a targeted AC scheme for Chinese patients with GC.     

A Case of Advanced Gastric Cancer With Long-Term Survival as the Results of Combined Radiation Therapy and Chemotherapy

A case report on a long-term surviving patient with advancedgastric cancer with supraclavicular lymph node metastasis treatedby radiation and chemotherapy is presented. The Borrman type 2 of advanced gastric cancer was found on thegreater curvature of the antrum at the first radiological examination. Radiation was administered to the supraclavicular lymph nodeat 60 Gy and to the stomach at 64 Gy. The patient received mitomycinC (24 mg) and Tegafur (230 g). After completion of the combinedtherapy the endoscopy revealed an irregular mucosal change witherosion and hemorrhage. Radiological examination revealed atrophicand hyperplastic areas throughout the stomach. These findingslasted more than six years. The patient died of unknown causein February 1983. She had survived nine years and seven monthsafter her initial diagnosis. Radiotherapy may play a role asa means of radical treatment in certain cases of advanced gastriccancer.     

调强放疗同步化疗治疗宫颈癌血液学毒性相关因素分析

目的 探讨调强放疗同步化疗治疗宫颈癌的过程中出现严重血液学毒性的相关因素。方法 回顾性分析126例调强放疗同步化疗的宫颈癌患者资料,对同步放化疗期间可能与严重血液学毒性相关的因素进行单因素和多因素分析。结果 单因素分析显示严重血液学毒性的发生与治疗前肌酐水平、放疗前是否接受化疗及是否有骨髓抑制、骨盆骨髓平均剂量、V20、V40及V50有关（P<0.05）。多因素分析显示骨盆骨髓平均剂量（OR: 1.004, 95%CI: 1.002~1.007）、V40（<41% vs. ≥41%, OR: 0.040, 95%CI: 0.007~0.235）、V50 （<9% vs. ≥ 9%, OR: 0.040, 95%CI: 0.011~0.152）和治疗前肌酐水平（<65 μmol/L vs.≥65 μmol/L, OR: 0.116, 95%CI: 0.030~0.441）与3~4级血液学毒性相关。结论 治疗前肌酐<65 μmol/L、V40<41%和V50<9%是宫颈癌患者同步放化疗期间3~4级血液学毒性发生率降低的相关因素。骨盆骨髓平均剂量越高,血液学毒性发生率增高。治疗前评估肾功能水平,严格控制骨盆骨髓的放疗照射体积及剂量,能减少宫颈癌患者血液学毒性发生,是顺利完成调强放疗同步化疗的保障。