顺铂与奈达铂同步放化疗治疗中晚期宫颈癌的临床对比研究

目的:探讨顺铂同步放化疗与奈达铂同步放化疗治疗中晚期宫颈癌的疗效和不良反应。方法:64例中晚期宫颈癌患者随机分为顺铂同步放化疗组(32例)和奈达铂同步放化疗组(32例),观察2组的近期和远期疗效以及不良反应。结果:顺铂同步放化疗组与奈达铂同步放化疗组的近期有效率分别为96.9%和100.0%(P>0.05)。顺铂同步放化疗组的3年生存率(71.88%)、局部复发率(12.50%)和远处转移率(6.25%)与奈达铂同步放化疗组(分别为70.97%、12.90%和6.45%)相比,差异均无统计学意义(P>0.05)。顺铂同步放化疗组的胃肠毒性和肾毒性发生率高于奈达铂同步放化疗组(P<0.05),而奈达铂同步放化疗组的血小板减少发生率高于顺铂同步放化疗组(P<0.05)。结论:顺铂单药同步放化疗与奈达铂单药同步放化疗均能明显提高中晚期宫颈癌患者的近期和远期疗效,并降低局部复发率和远处转移率。不良反应可以耐受。     

同步放化疗和单纯放疗治疗ⅡB～ⅢB期宫颈癌的疗效比较

背景与目的:同步放化疗已成为局部晚期宫颈癌的标准治疗模式,但对于放疗联合何种方案的化疗效果最佳,目前尚无一致意见.本研究中我们比较同步放化疗与单纯放疗,以及同步放化疗不同化疗方案的疗效及毒副反应.方法:2003年1月至2004年12月江西省妇幼保健院收治的符合人组标准的ⅡB～ⅢB期宫颈癌患者285例,按住院序号随机分为单纯放疗组142例,同步放化疗组143例.同步放化疗组又按化疗方案不同分为:BP(博来霉素 顺铂)方案同步放化疗51例,TP(紫杉醇 卡铂)方案同步放化疗47例,FP(氟尿嘧啶 顺铂)方案同步放化疗45例.比较单纯放疗组与同步放化疗组患者的3年生存率和不良反应,同时对同步放化疗三种不同化疗方案组的3年生存率及不良反应进行比较.结果:全组中位随访时间为42个月,单纯放疗组与同步放化疗组的3年生存率分别为65%和75%,两组比较差异有统计学意义(P=0.042).单纯放疗组Ⅲ～Ⅳ度急性毒副反应低于同步放化疗组(P<0.001),迟发性毒副反应两组差异无统计学意义(P=0.613).同步放化疗组BP方案、TP方案、FP方案的3年生存率分别为74%、80%和71%,三组间比较差异无统计学意义(P=0.792).三组Ⅲ～Ⅳ度急性及迟发性毒副反应发生率相似.结论:与单纯放疗相比,同步放化疗可明显提高ⅡB～ⅢB期宫颈癌患者的疗效.在同步放化疗三种不同的化疗方案中,紫杉醇联合卡铂方案组患者3年生存率略高于其他两种化疗方案,毒副反应可耐受,值得进一步研究.     

Cervical cancer in patients infected with the human immunodeficiency virus

BACKGROUND: The objective of this study was to compare the human immunodeficiency virus (HIV) viral load (VL) and CD4 counts in patients infected with HIV with and without cervical cancer. The authors hypothesized that HIV-positive women with cervical cancer would have a greater risk of immune suppression. METHODS: A case-control study was conducted that included all HIV-positive patients who were seen at the authors' institution from January 1, 1995 to April 20, 2006 with invasive cervical cancer (cases) and without invasive cervical cancer (controls). Patients were included only if they had a CD4 count recorded<6 months before or<3 months after their diagnosis of invasive cervical cancer (cases) or at their last gynecologic examination (controls). Controls were matched to cases on a 4:1 ratio according to current smoking history. Patients were considered immunocompetent if they had both a CD4 count>200 cells/microL and a VL<10,000 copies/mL. RESULTS: In total, 15 cases and 60 controls were identified. The median CD4 count for cases was 208 cells/microL (range, 18-1102 cells/microL) compared with 445 cells/microL (range, 20-1201 cells/microL) for controls (P=.03). The median VL was 16,918 copies/mL (range, 50-214,915 copies/mL) for cases compared with 1430 copies/mL (range, 50-571,000 copies/mL) for controls (P=.15). Only 1 of 14 cases (7%) was immunocompetent compared with 35 of 55 controls (64%; odds ratio, 0.04; 95% confidence interval, 0-0.37; P<.001). This significance was maintained after adjusting for other factors (P=.002). CONCLUSIONS: Women with HIV who were diagnosed with invasive cervical cancer appeared to have a much greater degree of immunosuppression than women with HIV without invasive cervical cancer.     

Survival is better predicted with a new classification of stage III unresectable non-small cell lung carcinoma treated by chemotherapy and radiotherapy

The 1997 International staging system (ISS) classification separated stage III non-small cell lung cancer (NSCLC) into stages IIIA and IIIB. In a previous study including unresectable NSCLC initially treated with chemotherapy, we analysed survival according to tumour (T) and node (N) stages and derived a classification into stages IIIbeta (T3-4N3) and IIIalpha (other TN stage III) that had a better discrimination on survival distribution. The aim of this study was to validate these results in a further set of patients. Patients with unresectable stage III NSCLC included in a phase III trial assessing the role of increased dose chemotherapy (SuperMIP: mitomycin 6 mg/m2, ifosfamide 4.5 g/m2, cisplatin 60 mg/m2, carboplatin 200 mg/m2) in comparison to standard chemotherapy MIP (mitomycin 6 mg/m2, ifosfamide 3 g/m2, cisplatin 50 mg/m2), before thoracic irradiation (60 Gy in 30 fractions over 6 weeks) were the subject of this study. Survival distributions were assessed by the method of Kaplan-Meier. Survival comparisons were made by the log-rank test. Multivariate analyses using Cox regression models, included all potential prognostic factors for survival with a P-value <0.2 in univariate analysis. According to the 1997 International staging system classification, 328 eligible patients were included in the study. There was no imbalance between the two arms. Five parameters were significantly associated (P < or = 0.05) with survival in univariate analysis: European lung cancer working party (ELCWP) staging (IIIalpha[n = 294 pts] versus IIIbeta [n = 46]), Karnofsky index, weight loss, platelet count and haemoglobin level. These variables as well as the 1997 ISS staging, white blood cell (WBC) count, LDH and sodium levels were included in a multivariate analysis. Two models were constructed, including either the ELCWP or the 1997 ISS. In model 1 (ISS included), Karnofsky index (HR 0.69; 95% confidence interval (CI) 0.47-1.00; P = 0.05) and haemoglobin (HR 1.49; 95% CI 1.11-1.99; P = 0.007) were found significant. In model 2, including ELCWP staging, two variables were associated with survival: ELCWP staging (HR 1.68; 95% CI 1.20-2.35; P = 0.002) and haemoglobin (HR 1.54; 95% CI 1.15-2.07; P = 0.01). CONCLUSION: In initially unresectable stage III NSCLC treated by chemotherapy and radiotherapy, we validated the results of our previous study. The classification into stages IIIbeta (T3-4N3M0) and IIIalpha (other TN stage III) better discriminates the patients in term of survival than the 1997 ISS classification.     

Effect of Hydronephrosis on Survival in Advanced Stage Cervical Cancer

Background: Hydronephrosis is frequently encountered in advanced stage cervical cancers, and may beassociated with mortality. In the present study, we aimed to demonstrate the effect of hydronephrosis on survivalin patients with inoperable advanced stage cervical cancer. Materials and Methods: The study data were acquiredby retrospective analysis of the patient records belonging to 165 women with FIGO (International Federation ofGynecology and Obstetrics) stage-IIIB or more advanced cervical cancer, which were not surgical candidates.Parameters including patient age, pathological diagnosis, disease stage, pelvic sidewall extension, presence ofhydronephrosis and administration of chemoradiation were analyzed. Further, the effects of these variables onsurvival were assessed. P values less than 0.05 were considered statistically significant. Results: The distributionof the study patients according to disease stage was as follows: 131 (79.4%) had stage-IIIB, 18 (10.9%) hadstage-IVB and 16 (% 9.7) patients had stage-IVA disease. Hydronephrosis was not evident in 91 (55.2%) ofthese patients, whereas 41 (24.8%) had unilateral and 33 (20%) patients had bilateral hydronephrosis. Whencompared to mean survival in patients who did not have hydronephrosis, survival was significantly shortened inpatients who had bilateral and unilateral hydronephrosis (p < 0.05). There was no significant survival differencebetween patients with unilateral and bilateral hydronephrosis (p>0.05). Although patient age, pathological type,pelvic involvement, and chemotherapy treatment rates were similar (p>0.05), radiotherapy requirement rate anddisease stage were significantly different among the study groups (p<0.05). Conclusions: Hydronephrosis wasfound to be a significant predictor of poor survival in patients with advanced stage cervical cancer, irrespectiveof unilateral or bilateral involvement.While waiting for future studies with larger sample sizes, we believe thatthe FIGO stages in advanced cervical cancer could further be stratified into subgroups according to presenceor absence of hydronephrosis.     

Patterns of care for cervical cancer in Auckland, New Zealand, 2003-2007

Introduction: The purpose of this review is to document current patterns of care for the International Federation of Gynecology and Obstetrics (FIGO) stage IB1 to IVA cervical cancer in a New Zealand cancer centre. Methods: This is a retrospective review of women with newly diagnosed FIGO Stage IB1–IVA cervical cancer in the Auckland/Northland regions between 2003 and 2007. Results: Two hundred seven patients were identified. Fifty‐three percent were stage IB, 24% stage II, 19% stage III and 3% stage IVA. Factors associated with stage ≥IIB were age >50, lack of participation in cervical screening and public first specialist assessment. Ninety percent (90/100) of stage IB1 patients and 73% (8/11) of stage IB2 patients were treated with primary surgery. Thirty‐eight percent of surgically treated stage IB1 and 100% of surgically treated stage IB2 tumours had indications for adjuvant radiotherapy. Radiotherapy utilisation rates were: stage IB 49% (IB1 44%, IB2 91%); stage II 93%; stage III 90%; and stage IVA 71%. Brachytherapy utilisation rate (BTU) for stages IIB to IVA was 64% overall and 75% in definitively treated patients. Seventy‐five percent of patients treated with definitive radiotherapy received concurrent cisplatin chemotherapy. Conclusion: Both radiotherapy and brachytherapy utilization rates were below optimal and are being addressed. No formal surgical or chemotherapy utilisation estimates exist for comparison; however, the use of concurrent cisplatin chemotherapy was similar to other groups. A high rate of adjuvant (chemo)radiotherapy was noted in surgically treated Stage IB patients, suggesting a need for an increased consideration of primary chemoradiotherapy in these patients to avoid the unnecessary toxicity of trimodality therapy. Future outcome analysis is planned.     

紫杉醇联合顺铂方案同步放疗治疗局部进展期宫颈癌的疗效分析

目的 分析紫杉醇联合顺铂方案同步放疗对局部进展期宫颈癌患者的疗效及不良反应.方法 选取局部进展期宫颈癌患者68例,FIGOⅢ~Ⅳa期,接受根治性放疗,累积剂量为80 Gy,同时每周给予顺铂30 mg/m2+紫杉醇50 mg/m2.观察记录患者的疗效及不良反应.结果 68例患者的不良反应包括胃肠道损害、贫血及脑梗死等,2年累积远期不良反应发生率为25%.中位随访时间27个月,2年PFS为83.8%(75.1%~92.6%),2年OS为92.7%(86.4%~98.9%),2年DM为13.2%(5.2%~21.3%).结论 紫杉醇联合顺铂同步放疗治疗局部进展期宫颈癌的疗效显著,且方案安全可行.     

紫杉醇联合顺铂治疗复发性宫颈癌的临床观察

Objective： To observe the efficacy and toxicities of paclitaxel plus cisplatin in the treatment of recurrent cervical cancer. Methods： Twenty-three patients with a diagnosis of recurrent cervical cancer were eligible. Three-weekly chemotherapy regimen consisted of paclitaxel 135-150 mg/m^2 infusion for 3 h on day 1, cisplatin 25 mg/m^2 infusion on day 1 to 3. All patients received at least two cycles treatment. Results： The response rates was 47.8%, including CR 2 cases （8.7%）, PR 9 cases （39.1%）. The major toxicity included neutropenia, nausea vomiting, arthralgia, myalgia and alopecia. Conclusion： Paclitaxel combined with cisplatin is an effective therapy with acceptable adverse reactions for recurrent cervical cancer.     

Efficacy and patterns of failure for locally advanced cancer of the cervix treated with celebrex (celecoxib) and chemoradiotherapy in RTOG 0128

PURPOSE: To determine the efficacy and patterns of initial failure for oral celecoxib, intravenous cisplatin, and 5-fluorouracil and concurrent pelvic radiotherapy in patients with locally advanced cancer of the cervix. METHODS AND MATERIALS: Patients were treated with concurrent 5-fluorouracil and cisplatin chemotherapy and pelvic radiotherapy and brachytherapy. Celecoxib was prescribed at a dose of 400 mg twice daily for 1 year beginning on the first day of radiotherapy. The overall and disease-free survival rates were determined. RESULTS: A total of 84 patients were accrued, of whom 78 were eligible. The estimated 2-year disease-free survival and overall survival rate was 69% and 83%, respectively. Of the 78 patients, 24 had treatment failure: 3 with persistent local disease, 9 local only, 2 regional, 4 distant, 1 regional and distant, 1 local and distant, and 2 with local, regional, and distant disease, and 1 had died of cervical cancer without a reported site of first failure and 1 without evidence of disease. CONCLUSION: At 2 years, the estimated disease-free survival and overall survival rate for patients with advanced cervical cancer who underwent a combination of chemoradiotherapy and celecoxib treatment was 69% and 83%, respectively. Recurrent disease developed in 24 patients, and, of those patients, 18 had a component of locoregional failure as a site of first failure. Thus, locoregional control continues to be problematic after chemoradiotherapy as delivered in our study. The identification of more active biologically targeted therapies is warranted for the treatment of advanced cancer of the cervix.     

Randomized comparison of weekly cisplatin or protracted venous infusion of fluorouracil in combination with pelvic radiation in advanced cervix cancer: a gynecologic oncology group study.

PURPOSE: Concurrent chemoradiotherapy is the standard of care for locally advanced cervix cancer; the optimal chemotherapy regimen is not yet defined. This trial was designed to compare the outcome of protracted venous infusion (PVI) fluorouracil (FU) with standard weekly cisplatin and concurrent radiation therapy (RT). PATIENTS AND METHODS: Patients with stage IIB, IIIB, and IVA cervical cancer with clinically negative aortic nodes were eligible. Pelvic RT dose was 45 Gy with a parametrial boost to involved sides of 5.4 to 9 Gy, and high- or low-dose rate intracavitary brachytherapy. Standard therapy was weekly cisplatin 40 mg/m2, and experimental therapy was PVI FU 225 mg/m2/d for 5 d/wk for six cycles during RT. RESULTS: The study was closed prematurely when a planned interim futility analysis indicated that PVI FU/RT had a higher treatment failure rate (35% higher) and would, most likely, not result in an improvement in progression-free survival compared with weekly cisplatin/RT. The PVI FU/RT arm continues to show a higher risk of treatment failure (relative risk [RR] unadjusted, 1.29) and a higher mortality rate (RR unadjusted, 1.37). There was no difference in pelvic treatment failure between regimens, but there was an increase in the failure rate at distant sites in the PVI FU arm. CONCLUSION: In this study, PVI FU does not show improved outcome over weekly cisplatin. Future research should explore combinations of FU with cisplatin, new radiosensitizers, and active drugs combined with RT to reduce the high rate of pelvic and distant treatment failure still seen in advanced cervix cancer.     

同步放化疗和新辅助化疗治疗ⅡB～ⅢB期子宫颈癌的疗效分析

目的探讨同步放化疗治疗ⅡB～ⅢB期子宫颈癌的疗效。方法将126例ⅡB～ⅢB期子宫颈癌患者随机分为同步放化疗组（治疗组）和化疗后放疗组（对照组）。对照组62例外照射加腔内治疗,当放疗剂量达到30Gy时用^192Ir腔内治疗,7．0Gy／次,1次／周。当外照射剂量达到46Gv时中间挡铅。A点剂量65～70Gy,B点剂量50—56Gy结束放疗,在放疗开始前给予顺铂（DDP）20mg静脉滴注,第1天至第5天,5-氟尿嘧啶（5-Fu）750mg静脉滴注,第1天至第5天,每28d重复。2个周期结束后开始放疗,放疗结束后继续原方案化疗2个周期,共4个周期。治疗组64例,放射治疗同对照组,在放疗开始时给予DDP20mg静脉滴注,第1天至第5天,5-Fu 750mg静脉滴注,第1天至第5天,每28d重复,共用4个周期。结果全部病例随访5年以上,随访率9414％。治疗组3、5年生存率分别为82．8％、65．6％;对照组3、5年生存率分别为67．7％、46．8％,两组差异有统计学意义（x^2=3．86,P〈0．05;x^2=5．01,P〈0．05）。两组生存曲线比较差异有统计学意义（x^2=4．26,P〈0．05）,不良反应差异无统计学意义。结论同步放化疗治疗晚期子宫颈癌疗效好,可以提高3、5年生存率。不良反应无明显增加。     

Oral vinorelbine and cisplatin with concomitant radiotherapy in stage III non-small cell lung cancer (NSCLC): a feasibility study

BACKGROUND: Concurrent chemoradiotherapy has improved survival in inoperable stage III non-small cell lung cancer (NSCLC). This phase I trial was performed in order to establish a dose recommendation for oral vinorelbine in combination with cisplatin and simultaneous radiotherapy. PATIENTS AND METHODS: Previously untreated patients with stage IIIB NSCLC received concurrent chemoradiotherapy with 66 Gy and 2 cycles of cisplatin and oral vinorelbine which was administered at 3 different levels (40, 50 and 60 mg/m2). This was to be followed by 2 cycles of cisplatin/ vinorelbine oral consolidation chemotherapy. The study goal was to determine the maximal recommended dose of oral vinorelbine during concurrent treatment. RESULTS: 11 stage IIIB patients were entered into the study. The median radiotherapy dose was 66 Gy. Grade 3-4 toxicity included neutropenia, esophagitis, gastritis and febrile neutropenia. The dose-limiting toxicity for concurrent chemoradiotherapy was esophagitis. 9 patients received consolidation chemotherapy, with neutropenia and anemia/thrombocytopenia grade 3 being the only toxicities. The overall response was 73%. CONCLUSION: Oral vinorelbine 50 mg/m2 (days 1, 8, 15 over 4 weeks) in combination with cisplatin 20 mg/m2 (days 1-4) is the recommended dose in combination with radiotherapy (66 Gy) and will be used for concurrent chemoradiotherapy in a forthcoming phase III trial testing the efficacy of consolidation chemotherapy in patients not progressing after chemoradiotherapy.     

复方斑蝥胶囊联合同步放化疗在宫颈癌中的应用

目的：观察复方斑蝥胶囊联合同步放化疗治疗局部晚期宫颈癌的临床疗效及不良反应。方法选取湖北医药学院附属人民医院肿瘤中心2013年9月—2014年9月期间收治的符合入组条件的80例ⅡB ～ⅣA 期宫颈癌患者,采用随机数字表法将研究对象分为观察组（n ＝40）和对照组（n ＝40）。观察组采用复方斑蝥胶囊联合同步放化疗,对照组采用单纯同步放化疗。同步放化疗中化疗方案采用 TP 方案即紫杉醇＋顺铂,放疗采用适形调强放疗（IMRT）＋腔内后装放疗。比较两组有效率、治疗期间 Karnofsky 功能状态（KPS）评分、急性不良反应。结果观察组与对照组近期有效率分别为97．5％和95．0％,差异无统计学意义（χ2＝0．353,P ＝0．500）。观察组与对照组Ⅲ～Ⅳ级不良反应主要包括白细胞减少（80．0％∶95．0％）、血红蛋白降低（22．5％∶45．0％）、血小板减少（60．0％∶82．5％）、放射性膀胱炎（5．0％∶30．0％）及放射性直肠炎（10．0％∶30．0％）,差异均有统计学意义（χ2＝4．114,P ＝0．043;χ2＝4．528,P ＝0．033;χ2＝4．943,P ＝0．026;χ2＝8．658,P ＝0．003;χ2＝5．000,P ＝0．025）。治疗后观察组 KPS 评分中位值高于对照组（90分∶70分）,差异有统计学意义（Z ＝4．523,P ＝0．000）。结论复方斑蝥胶囊联合同步放化疗与单纯同步放化疗治疗宫颈癌疗效相当,加入复方斑蝥胶囊能降低白细胞减少、血红蛋白降低、血小板减少、放射性直肠炎、放射性膀胱炎发生率,提高患者 KPS 评分,起到减毒作用。     

Uracil/tegafur plus cisplatin with concurrent radiotherapy for locally advanced non-small-cell lung cancer: a multi-institutional phase II trial.

PURPOSE: To evaluate the efficacy and toxicity of a novel combination treatment using concurrent radiotherapy with cisplatin plus UFT, which is comprised of uracil and tegafur, in locally advanced non-small cell lung cancer (NSCLC) patients. EXPERIMENTAL DESIGN: In this Phase II trial, patients with unresectable stage III NSCLC were treated with the oral administration of UFT (400 mg/m(2)/d tegafur) on days 1-14 and days 29-42 whereas 80 mg/m(2) cisplatin was administered i.v. on days 8 and 36. Radiotherapy, with a total dose of 60 Gy, was delivered in 30 fractions from day 1. RESULTS: Seventy patients were enrolled and eligible, as follows: 57 males/13 females; mean age 61 ranging from 36 to 74; performance status 0/1:45/25; stage IIIA/IIIB, 14/56. A complete response was observed in two patients and a partial response in 54 patients, and the overall response rate was 81% (95% confidence interval; 70-89%). The median survival, the 1- and 2-year survival rates were 16.5 months, 67% and 33%, respectively. Grade 3/4 leukopenia occurred in 14%/1% of the patients. Grades 3 non-hematological toxicities were only reported in three patients with nausea, two with esophagitis and one with pneumonitis whereas no grade 4 non-hematological toxicity was observed. CONCLUSIONS: UFT plus cisplatin with concurrent radiotherapy is considered to be a feasible and effective treatment for locally advanced NSCLC patients. Additional study of this concurrent chemoradiotherapy is warranted.     

Mature results from a phase II trial of accelerated induction chemoradiotherapy and surgery for poor prognosis stage III non-small-cell lung cancer.

Mature results are reported from a phase II trial of accelerated induction chemoradiotherapy and surgical resection for stage III non-small-cell lung cancer whose prognosis is poor. Surgically staged patients with poor prognosis stage III non-small-cell lung cancer were eligible for this study. Four-day continuous intravenous infusions of cisplatin 20 mg/m2/day, 5-fluorouracil 1,000 mg/m2/day, and etoposide 75 mg/m2/day were given concurrently with accelerated fractionation radiation therapy, 1.5 Gy twice a day, to a total dose of 27 Gy. Surgical resection followed in 4 weeks. Identical postoperative chemotherapy and concurrent radiation to a total dose of 40 to 63 Gy was subsequently given. Between February 1991 and June 1994, 42 eligible and evaluable patients, 23 with stage IIIA disease and 19 with stage IIIB disease, were entered in this trial. Treatment was well tolerated. The pathologic response rate was 40%. This response was complete in 5%. With a median follow-up of 54 months, the Kaplan-Meier 4-year survival estimate is 19%: 26% for stage IIIA and 11% for stage IIIB patients. Patients with a pathologic response, resectable disease, or pathologic downstaging to stage 0, I, or II had a better survival. The 4-year estimates of locoregional and distant disease control are 70% and 19%, respectively. It is concluded that although the ultimate role of concurrent chemoradiotherapy and surgery in stage III non-small-cell lung cancer must await the results of phase III clinical trials, survival and locoregional control in this study appear improved in comparison with historical experience. There is a subset of patients, able to undergo resection with pathologic downstaging, who have a projected survival equivalent to that of patients with more limited disease. Clinical or pathologic tools to identify these patients before treatment would be highly useful.     

The European Cancer Anaemia Survey (ECAS): a large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients

The European Cancer Anaemia Survey (ECAS) was conducted to prospectively evaluate the prevalence, incidence and treatment of anaemia (haemoglobin <12.0 g/dL) in European cancer patients, including the relationship of mild, moderate and severe anaemia to performance status. Patients were evaluated for up to 6 months. Data (N=15367) included demographics, tumour type, performance status, haemoglobin levels, cancer treatments and anaemia treatments. Prevalence of anaemia at enrollment was 39.3% (haemoglobin <10.0 g/dL, 10%), and 67.0% during the survey (haemoglobin <10.0 g/dL, 39.3%). Low haemoglobin levels correlated significantly with poor performance status. Incidence of anaemia was 53.7% (haemoglobin <10.0 g/dL, 15.2%). Anaemia was treated in 38.9% of patients (epoetin, 17.4%; transfusion, 14.9%; and iron, 6.5%). Mean haemoglobin to initiate anaemia treatment was 9.7 g/dL. Anaemia prevalence and incidence in cancer patients are high. Anaemia significantly correlates with poor performance status and many anaemic patients are not treated.     

Weekly Cisplatin versus Standard Three-weekly Cisplatin in Concurrent Chemoradiotherapy of Head and Neck Cancer: the Baskent University Experience

Background: The majority of patients with head and neck cancer are treated with concurrentchemoradiotherapy. However, toxicity is substantial so that alternate schedules of cisplatin have been tried toovercome this problem. No formal comparison, however, has been reported between alternate schedules andreference regimen. Patients and methods: Fifty-five eligible patients treated with concurrent chemoradiotherapywere retrospectively analyzed. The patients treated with weekly cisplatin were defined as group A, while thepatients treated with standard regimen were defined as group B. Basic demographics and clinical characteristics’,overall survival rate, locoregional or systemic relapse rates, and time to local/systemic relapse were recorded.Results: One, two, and three-year probability of survival in groups A and B were 75% to 65% after one year,63% to 56%after two, and 63% to 52% after three, respectively. Although time to local and systemic relapse washigher in group B as compared to group A, a statistical analysis was failed to show any significant difference.Furthermore, there was no significant difference between groups with respect to major toxicity. Conclusion: Inpatients with head and neck cancer, concurrent chemoradiotherapy with weekly cisplatin might be as effectiveas concurrent chemoradiotherapy with bolus cisplatin.     

A Randomized Controlled Trial Comparing Clinical Outcomes and Toxicity of Lobaplatin- Versus Cisplatin-Based Concurrent Chemotherapy Plus Radiotherapy and High-Dose-Rate Brachytherapy for FIGO Stage II and III Cervical Cancer

Background: We designed this randomized controlled trial (RCT) to assess whether lobaplatin-basedconcurrent chemotherapy might be superior to cisplatin-based concurrent chemotherapy for FIGO stage II andIII cervical cancer in terms of efficacy and safety. Materials and Methods: This prospective, open-label RCTaims to enroll 180 patients with FIGO stage II and III cervical cancer, randomly allocated to one of the threetreatment groups (cisplatin 15mg/m2, cisplatin 20mg/m2 and lobaplatin 35mg/m2), with 60 patients in each group.All patients will receive external beam irradiation (EBRT) and high-dose-rate intracavitary brachytherapy(HDR-ICBT). Patients in cisplatin 15mg/m2 and 20mg/m2 groups will be administered four cycles of 15mg/m2or 20mg/m2 cisplatin intravenously once weekly from the second week to the fifth week during EBRT, whilepatients inthe lobaplatin 35mg/m2 group will be administered two cycles of 35mg/m2 lobaplatin intravenouslyin the second and fifth week respectively during pelvic EBRT. All participants will be followed up for at least 12months. Complete remission rate and progression-free survival (PFS) will be the primary endpoints. Overallsurvival (OS), incidence of adverse events (AEs), and quality of life will be the secondary endpoints. Results:Between March 2013 and March 2014, a total of 61 patients with FIGO stage II and III cervical cancer wererandomly assigned to cisplatin 15mg/m2 group (n=21), cisplatin 20mg/m2 group (n=21) and lobaplatin 35mg/m2group (n=19). We conducted a preliminary analysis of the results. Similar rates of complete remission and grades3-4 gastrointestinal reactions were observed for the three treatment groups (P=0.801 and 0.793, respectively).Grade 3-4 hematologic toxicity was more frequent in the lobaplatin group than the cisplatin group. Conclusions:This proposed study will be the first RCT to evaluate whether lobaplatin-based chemoraiotherapy will havebeneficial effects, compared with cisplatin-based chemoradiotherapy, on complete remission rate, PFS, OS, AEsand quality of life for FIGO stage II and III cervical cancer.     

宫颈癌根治性放化疗预后的影响因素分析

目的:分析宫颈癌根治性放化疗预后的影响因素,为宫颈癌的治疗提供最佳放化疗结合模式。方法:回顾性分析2009年7月至2014年1月收治的213例接受根治性放化疗的宫颈癌患者的临床资料。放疗采用三维适形放射治疗技术,化疗方案以铂类药物为基础。Kaplan-Meier法计算OS,采用Logrank法检验并进行单因素分析,Cox风险回归模型进行多因素预后分析。结果:随访率96.7%,全组1、3、5年OS 为96.7%、79.3%和65.2%。单因素分析显示影响OS因素为年龄、分期。多因素分析分期和化疗周期数是影响OS的独立预后因素。结论:同步放化疗模式是治疗宫颈癌的主要方法,化疗周期数3~4次,可能是最佳的化疗次数,可以预防远处转移和改善总生存。     

18F-FDG PET/CT代谢参数对ⅡB期宫颈癌放化疗疗效的预测价值

目的 探讨18F-FDG PET/CT代谢参数在ⅡB期宫颈癌放化疗疗效中的预测价值。方法 回顾性队列分析29例行同步放化疗的ⅡB期宫颈癌患者,治疗前均行18F-FDG PET /CT全身显像检查,并获取代谢参数如最大标准摄取值（maximum standardized uptake values,SUVmax）、平均标准摄取值（average standardized uptake values,SUVavg）、最小标准摄取值（minmum standardized uptake values,SUVmin）、峰值标准摄取值（peak standardized uptake values,SUVpeak）、肿瘤代谢体积（metabolic tumor volume,MTV）、病灶糖酵解总量（total lesion glycolysis,TLG）,根据疗效评价标准分为放化疗敏感组和放化疗抵抗组,分析18F-FDG PET/CT代谢参数与ⅡB期宫颈癌放化疗疗效的关系 ,并采用受试者工作特征（receiver operating characteristic,ROC）曲线评估其预测放化疗疗效的价值。结果 放化疗敏感组的SUVmax、SUVavg、SUVpeak、SUVmin值与放化疗抵抗组比较差异无统计学意义（均P>0.05）,放化疗敏感组与放化疗抵抗组的TLG、MTV比较差异有统计学意义（P=0.025,0.009）。TLG和MTV的ROC曲线下面积分别为0.753和0.793,MTV预测放化疗疗效的敏感度、特异度和准确度分别为77.8％、81.8％和79.3％;TLG分别为66.7％、81.8％和75.3％。结论 18F-FDG PET/CT代谢参数在ⅡB期宫颈癌放化疗疗效中具有良好的预测价值。