70岁以上老年人非小细胞肺癌的放射治疗

目的　了解老年人非小细胞肺癌 ( NSCLC)放射治疗临床特点。　方法　对 1 3 5例完成根治性放疗的老年 NSCLC患者施行常规和非常规分割放疗 ,其中 52例在放疗前或 (和 )放疗后接受中位数 2周期 ( 1～ 9周期 )的化疗。　结果　按时完成放疗者 89例 ,4 4例疗程有中断。总的 1、2、3年生存率分别为 76%、3 9%、2 3 %;局部控制率分别为 64 %、4 2 %、4 0 %;无远处转移者 1、2、3年生存率分别为 70 %、52 %、3 6%。3 3 %( 44 /1 3 5)未接受连续放疗 ,中断原因 :患者不能耐受 3 1例 ,化疗 4例 ,其他 9例。不同放疗分割方式及辅助化疗对疗程中断无影响 ( P>0 .0 5)。放疗连续组与中断组比较 ,放疗疗程中断明显影响生存率 ( P<0 .0 5)、局控率 ( P<0 .0 1 )。　结论　老年 NSCLC完成根治性放疗后有较好的疗效。部分患者对根治性放疗耐受性较差 ,与放疗分割方式及非正规化疗无关。放疗耐受性差的患者预后较差。     

紫杉醇联合化疗治疗晚期非小细胞肺癌43例疗效观察

目的 评价紫杉醇联合顺铂或卡铂对晚期非小细胞肺癌的疗效和毒副作用。方法 43例晚期非小细胞肺癌应用紫杉醇175mg/m^2和顺铂80mg/m^2或卡铂350mg/m^2联合化疗,每3－4周一次,2－3周期为一疗程。结果 43例总有效率39．5％,紫杉醇加顺铂29例,有效率44．8％;紫杉醇加卡铂14例,有效率为28．6％。复治病例14例,有效率42．9％。主要毒副作用是骨髓抑制、脱发、手足麻木、关节肌肉瘤、心脏毒性反应。结论 紫杉醇联合顺铂或卡铂是治疗晚期非小细胞肺癌的有效方案,安全且耐受。     

The current status of targeted therapy for non‐small cell lung cancer

Lung cancer accounts for more cancer‐related deaths than any other malignancy in Australia and worldwide. Non‐small cell lung cancer (NSCLC) accounts for about 85% of lung cancers and is associated with a 5‐year survival of only 15%. Treatment with platinum‐based doublets in the first‐line setting and single agent chemotherapy in the second‐line setting has improved survival and quality of life in patients with NSCLC. However, the benefits associated with chemotherapy are modest and serve to stress the need for novel therapeutic approaches. In the last decade a range of targeted therapies has been evaluated in NSCLC. Dramatic and often durable responses were seen in patients treated with the epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKI) gefitinib and erlotinib particularly in females, non‐smokers, patients of East Asian ethnicity and those with adenocarcinomas – a group subsequently found to be enriched for tumours with activating EGFR mutations. Large randomized phase III trials have since established a role for EGFR TKI in the second‐ and third‐line setting as well as a potential role for the monoclonal antibodies bevacizumab and cetuximab, directed at vascular endothelial growth factor and EGFR, respectively, in the combination with chemotherapy in the first‐line setting. Recently it has been shown that patients with EGFR mutations may benefit from gefitinib in the first‐line setting. Other promising agents under evaluation are inhibitors of the insulin‐like growth factor‐1 receptor and inhibitors of recently described ALK gene rearrangements.     

非小细胞肺癌常规外照射同步适形放疗临床应用探讨

目的探讨肺癌放疗新方法，提高治愈率，降低转移率。方法对48～80岁8例非小细胞肺癌患者采用常规外照射加同步适形放疗，每周1、3、5适形放疗，每次5Gy，共6次，DT：30Gy。每周2、4普通外照射，每日1次，每次2Gy，普放、适形同步结束后，继续普放至DT：40Gy／20次结束。放疗中剂量达到20Gy，适形结束和普放结束分别进行CT或X线片检查，了解病灶缩小的时间和程度。采用同期普放的5例和后程适形1例共6例非小细胞肺癌作初步对照，观察他们的病情变化情况。结果（1）同步组放疗病人均可耐受，治疗期间无特殊反应。（2）同步组并未增加放射性食管炎和放射性肺炎的发生率。（3）同步组较普放组在肿瘤缩小的时间上提前1～2周，程度上也明显好于普放组。结论对非小细胞肺癌采用普放加适形放疗同步进行，未增加放射反应，疗效好，值得临床推广应用。     

LKB1、VEGFR2在非小细胞肺癌组织中表达及临床意义的研究

目的探究人Liver kinase B1(LKB1)与血管内皮生长因子受体-2(VEGFR2)在非小细胞肺癌组织中的表达情况,并探究其临床意义。方法采用免疫组化方法测定65例非小细胞肺癌组织及40例癌旁组织LKB1、VEGFR2表达情况。分析LKB1、VEGFR2表达情况与临床病理特征的相关性。结果肺癌组织中LKB1阳性率低于癌旁组织,VEGFR2阳性率高于癌旁组织。LKB1在腺癌中的表达阳性率高于鳞癌,VEGFR2在腺癌中的表达阳性率低于鳞癌。在具有吸烟史、淋巴转移、临床低分期以及低分化程度中LKB1阳性率更低,VEGFR2阳性率更高,差异均有统计学意义(均P0.05)。结论腺癌组织中LKB1表达水平高于鳞癌组织;非小细胞肺癌组织中LKB1、VEGFR2呈现相反的表达趋势。LKB1低表达与VEGFR2高表达提示肺癌患者具有吸烟史、出现淋巴转移、高临床分期以及低分化程度。     

卡铂、氟尿嘧啶化疗结合放射治疗非小细胞肺癌疗效分析

目的　观察卡铂（ Ｃ） 、氟尿嘧啶（ Ｆ） 化疗加放射治疗（ 放疗） 对中晚期非小细胞肺癌（ Ｎ Ｓ Ｃ Ｌ Ｃ） 的疗效。方法　选择中晚期 Ｎ Ｓ Ｃ Ｌ Ｃ８０ 例随机入 Ｃ Ｆ＋ 放疗和单纯放疗组,两组病例均给予常规放疗, Ｃ Ｆ＋ 放疗组放疗第１ 、４ 周给予化疗,卡铂１００ ｍｇ、氟尿嘧啶５００ ｍｇ 静脉滴注,每周连用５ 天。结果　近期疗效完全缓解率 Ｃ Ｆ＋ 放疗组为４８ ％ ,单纯放疗组为２５ ％ ,１ 、３ 、５ 年生存率 Ｃ Ｆ＋ 放疗组分别为６３ ％ 、３８ ％ 和１８ ％ ,较单纯放疗组的４０ ％ 、１５ ％ 和８ ％ 有明显提高, Ｃ Ｆ＋ 放疗组毒副反应主要是Ⅰ、Ⅱ度骨髓抑制和消化道反应。结论　卡铂、氟尿嘧啶化疗结合放疗,能提高 Ｎ Ｓ Ｃ Ｌ Ｃ 的疗效及生存率。     

Gefitinib in advanced non-small cell lung cancer

BACKGROUND: Gefitinib is an oral, selective epidermal growth factor receptor (EGFR) inhibitor that has activity in non-small cell lung cancer (NSCLC). AIM: To evaluate the tolerability, safety-profile and response of single agent gefitinib in patients with advanced stage NSCLC. METHODS: Twenty-seven patients of good performance status with stage IIIB or IV NSCLC were entered on the study at the Sydney Cancer Centre. Gefitinib was prescribed at an oral dose of 250 mg daily, as a continuous dose. Radiological evaluation of indicator lesions occurred at baseline and were repeated every 2-3 months until disease progression. Toxicity was graded using standard measures at baseline and at every month. RESULTS: The response rate was 17% in the patients eligible for evaluation. Symptom improvement was observed in 75% of patients. No patients withdrew because of adverse events. Toxicity was observed in 15 patients and consisted mainly of rash (59%), which was usually mild in severity. CONCLUSION: Gefitinib is active in NSCLC. It is well tolerated with minimal side-effects. Symptomatic improvement was found in the majority of patients treated with gefitinib. There may be a role for gefitinib in the palliation of symptoms in patients with advanced NSCLC.     

国产吉西他滨联合顺铂治疗晚期复治非小细胞肺癌21例临床研究

目的评价国产吉西他滨联合顺铂治疗晚期复治非小细胞肺癌的疗效和毒副反应。方法21例有病理或细胞学诊断的晚期非小细胞肺癌患者,给予国产吉西他滨0.8g/m2d1,5静脉点滴;顺铂40m g/m2d1-3静脉滴注。21天重复,2周期后评价疗效和毒副反应。结果CR 0例,PR 7例,SD 6例,PD 8例,有效率33.3%。生活质量改善。不良反应主要为骨髓抑制,消化道反应、发热和皮疹。结论国产吉西他滨联合顺铂方案治疗晚期复治非小细胞肺癌,疗效较好,毒副反应能耐受。     

EGFR和K-ras基因表达突变与非小细胞肺癌预后的关联分析

目的探讨EGFR和K-ras基因表达突变与非小细胞肺癌(NSCLC)预后的关系。方法纳入126例NSCLC患者,使用免疫组织化学染色和基因测序检测其肿瘤组织EGFR和K-ras基因的表达突变情况,按NCCN指南对患者进行标准治疗和随访,采用Kaplan-Meier曲线、Log rank检验和Cox比例风险模型分析不同基因表达突变患者的中位生存期、5年总生存率和生存期的影响因素。结果 EGFR基因的阳性表达率为49.21%,突变率为28.57%,K-ras基因的阳性表达率为42.06%,突变率为2.38%;K-ras(+)的中位生存期和5年总生存率均显著低于K-ras(-)患者(χ2=4.348,Log-rank P=0.037),EGFR(突变)的中位生存期和5年总生存率均显著高于EGFR(野生)患者(χ2=11.518,Log-rank P=0.001);双基因阳性(P=0.027,HR=2.584,95%CI:1.113~6.002)和远处转移(P=0.046,HR=2.104,95%CI:1.013~4.369)是影响NSCLC患者生存期的危险因素,使用靶向药物治疗是生存期的保护因素(P0.001,HR=0.293,95%CI:0.149~0.574)。结论 EGFR和K-ras基因的表达突变与NSCLC患者的预后密切相关,双基因阳性可降低患者生存时间,它们是患者个体化用药和预后判断的重要指标。     

非小细胞肺癌组织中KiSS-1的表达及意义

目的探讨KiSS-1基因在非小细胞肺癌（NSCLC）发生、发展中的作用。方法采用免疫组化sP法检测61例NSCLC组织（观察g1）和20例正常肺组织（对照组）中的KiSS-1表达，并分析与NSCLC临床病理参数的关系。结果观察组中KiSS-1阳性表达率为50．8％，明显低于对照组的80．0％（P〈0．05）；KiSS-1表达与NSCLC临床分期、肿瘤体积、淋巴结转移、4a生存率密切相关。结论KiSS-1在NSCLC的发生、发展中发挥重要作用，可作为预测NSCLC发生及侵袭转移的参考指标之一。     

Spontaneous regression of small cell lung cancer

Abstract:   Spontaneous regression of cancers is extremely rare and is associated with specific malignancies. Spontaneous regression of bronchogenic lung cancer has rarely been reported, and regression of small cell lung cancer is even less common. Such regression is generally ascribed to immunological factors but is not well understood. This case report describes a patient with spontaneous regression of small cell lung cancer that has persisted for 11 years and considers possible mechanisms.     

厄洛替尼治疗化疗失败的晚期肺癌的临床研究

目的探讨厄洛替尼治疗化疗失败的晚期非小细胞肺癌（NSCLC）患者的临床疗效和毒副反应。方法 43例经化疗失败的晚期NSCLC患者每日口服厄洛替尼150mg治疗,直至病情进展或患者不能耐受毒副反应时停药,对临床疗效、无疾病进展时间和毒副反应等进行分析。结果全组43例患者中PR14例,占32.6%;SD12例,占27.9%;PD17例,占39.5%;疾病控制率（CR＋PR＋SD）为60.5%。常见毒副反应为皮疹、腹泻。结论厄洛替尼治疗化疗失败的晚期NSCLC有一定疗效,毒副反应轻。     

厄洛替尼治疗老年非小细胞肺癌的疗效和安全性

目的 评价厄洛替尼在中国老年晚期非小细胞肺癌（NSCLC）患者中的安全性、疗效以及临床因素与疗效之间的关系。方法 回顾性分析2005年3月至2010年10月于北京协和医院呼吸内科服用厄洛替尼的非临床试验的43例老年NSCLC患者的临床资料,分析其生存情况及相关临床因素对生存的影响。结果 43例患者中,部分缓解（PR）12例,病情稳定（SD）17例,疾病进展（PD）14例,客观有效率（ORR）为27.9%,疾病控制率（DCR）为67.4%。影响ORR的临床因素有性别（P＝0.001）、肿瘤分化程度（P＝0.022）和吸烟史（P＝0.001）;影响DCR的因素有性别（P＝0.031）、美国东部肿瘤协作组（ECOG）评分（P＝0.004）、肿瘤分化程度（P＝0.018）、吸烟史（P＝0.005）和服药后皮疹（P＜0.001）。服药后中位无进展生存期（PFS）为27周（95%CI：8.32～45.7周）,服药后总生存期（OS）为46周（95%CI：26.7～65.3周）。对PFS有显著影响的临床因素包括病理类型（P＝0.024）、肿瘤分化程度（P＝0.036）、ECOG评分（P＝0.001）、服药后皮疹（P＝0.006）;而病理类型（P＝0.040）、肿瘤分化程度（P＝0.023）、ECOG评分（P＜0.001）、使用厄洛替尼后续治疗（P＝0.028）对OS有显著影响。EGFR19/21外因子突变阳性的患者ORR（P＝0.004）和DCR（P＝0.033）均显著高于阴性组,中位PFS也显著高于阴性组（46.1 vs 12.8周,P＝0.004）。常见副反应为皮疹（51.2%）和腹泻（23.2%）。结论 使用厄洛替尼治疗我国老年晚期NSCLC患者的疗效和安全性均较好,体能状态良好的患者尽早使用厄洛替尼可能获得更好的疗效。     

非小细胞肺癌患者CD166、MMP-9表达水平与转移及预后的关系

目的分析非小细胞肺癌(NSCLC)患者CD166、MMP-9表达水平与转移及预后的关系。方法选取2014年1月到12月内在我院接受肺癌根治术切除的82例NSCLC患者,采用免疫组化法对所有患者行CD166、MMP-9表达水平的检测并对比检测结果。结果 CD166在有无淋巴结转移以及TNM分期中的组内差异较大,差异具有统计学意义(P0.05);MMP-9在有无淋巴结转移以及TNM分期中的组内差异较大,P0.05;经过Spearman相关性分析,NSCLC患者的CD166、MMP-9与淋巴结转移成负相关。结论 MMP-9以及CD166在NSCLC转移淋巴结中为高表达,其淋巴结转移可能与CD166或MMP-9有关,且CD166及MMP-9的阳性表达患者的预后较差。     

四种化疗方案治疗晚期非小细胞肺癌的疗效比较

目的 探讨不同化疗方案治疗晚期非小细胞肺癌的疗效。方法 114例晚期非小细胞肺癌患者分别用四组不同的方案化疗,vIP40例,NP36例,GP21例,TP17例,四组患者资料具有可比性。结果 VIP有效率42．5％,肿瘤控制率72．5％;NP有效率47．2％,肿瘤控制率80．6％;GP有效率52．4％,肿瘤控制率90．5％;TP有效率58．8％,肿瘤控制率94．1％。四种方案有效率比较无统计学差异（P〉0．05）,肿瘤控制率比较有统计学差异（P〈0．05）。结论 四种化疗方案均对晚期非小细胞肺癌有效,但TP方案在肿瘤控制率及化疗副反应方面占优势,而NP方案疗效比较高,可作为经济条件较差晚期NSCLC患者首选方案。     

Pemetrexed plus platinum or gemcitabine plus platinum for advanced non‐small cell lung cancer: final survival analysis from a multicentre randomized phase II trial in the East Asia region and a meta‐analysis

Background and Objective: Pemetrexed plus platinum has shown efficacy as a first‐line treatment for advanced non–small cell lung cancer (NSCLC), but little is known about its efficacy and safety in East Asian patients. We report the final analysis of overall survival (OS) from a multicentre, randomized, phase II trial in chemotherapy‐naive Chinese patients with advanced NSCLC. An additional meta‐analysis was performed to systematically evaluate pemetrexed/platinum as first‐line treatment for advanced NSCLC. Methods: Eligible patients received up to six cycles of pemetrexed, 500 mg/m² plus cisplatin, 75 mg/m² (day 1) or gemcitabine, 1000 mg/m² (days 1 and 8) plus cisplatin, 75 mg/m² (day 1). OS and toxicity were assessed. Results: A total of 254 patients were randomized, and 251 were eligible for inclusion in the efficacy and safety analyses. Median OS in the pemetrexed/cisplatin arm was 15.3 months, compared with 16.9 months in the gemcitabine/cisplatin arm [hazard ratio (HR) 1.09; 95% confidence interval (CI) 0.80–1.48; log‐rank P = 0.4888). There was a trend towards improved survival in both arms. Patients in the pemetrexed/cisplatin arm showed a lower incidence of drug‐related grade 3 to 4 leukopenia and thrombocytopenia. Meta‐analysis showed that pemetrexed‐platinum treatment was associated with 19% longer survival among females (HR 0.81; 95% CI 0.69–0.96) and 17% longer survival among patients with non‐squamous cell lung cancer (HR 0.83; 95% CI 0.73–0.95). Conclusions: In Chinese patients with advanced NSCLC, pemetrexed/cisplatin treatment resulted in comparable OS outcomes and was better tolerated than gemcitabine/cisplatin. Meta‐analysis supports the use of pemetrexed‐platinum as first‐line treatment for female patients and those with the non‐squamous cell subtype of advanced NSCLC.     

厄洛替尼治疗晚期非小细胞肺癌近期疗效和安全性研究

目的 评价厄洛替尼治疗晚期非小细胞肺癌(NSCLC)的近期疗效.方法 21例确证的化疗失败的Ⅲb/Ⅳ期NSCLC患者入组,给予厄洛替尼150mg/d口服,直至疾病进展,观察近期疗效和不良反应.结果 21例患者中完全缓解0例,部分缓解7例,客观缓解率为33.3％;稳定6例,疾病控制率为61.9％;女性疾病控制率优于男性(P＜0.05),而吸烟、肿瘤类型、皮疹及腹泻均与客观缓解率和疾病控制率无关(P＞0.05);主要毒副反应为1/2度皮疹和腹泻,发生率分别为80％和42.9％.结论 厄洛替尼能有效治疗晚期NSCLC,女性疗效更佳,且不良反应少.     

Retreatment with pemetrexed chemotherapy in advanced non-small cell lung cancer patient

Objective

The aim of this study was to evaluate the feasibility and safety of retreatment the pemetrexed after the failure prior pemetrexed-based chemotherapy in non-small cell lung cancer (NSCLC) from our institute.

Patients and methods

Patients with advanced NSCLC who were admitted to Zhejiang Cancer Hospital from Dec 2009 to Dec 2012 were retrospectively analyzed. All of the patients were given pemetrexed chemotherapy after the prior pemetrexed-based treatment. Survival analysis was evaluated by Kaplan-Meier method.

Results

Twenty-five patients were included in current study. Initial pemetrexed-based therapy was given as first-line treatment in all patients. Nine patients retreated with pemetrexed as the fourth-line treatment, and sixteen as further-line. One patient (4%) achieved partial response (PR), 9 (36%) with stable disease (SD), and 15 (60%) had progressive disease (PD). The disease control rate (DCR) was 40% and the median progression-free survival (PFS) was 1.5 months (95% CI: 0.8-2.4 months). Patients with an initial PFS >6 months had a median PFS after retreatment of 2.2 months, while patients with an initial pemetrexed PFS ≤6 months had a median PFS after retreatment of 1.1 months (P=0.036). The toxicities associated with the 2nd pemetrexed were generally acceptable.

Conclusions

Retreatment of pemetrexed seems to be a potential therapeutic option for treatment of selected advanced NSCLC patients after failure of initial pemetrexed therapy, especially for the patients with a PFS more than 6 months in the initial pemetrexed treatment.