紫杉醇联合奈达铂化疗同步适形调强放疗治疗局部晚期食管癌的疗效

目的：探讨紫杉醇联合奈达铂化疗同步适形调强放疗治疗局部晚期食管癌的疗效。方法选取局部晚期食管癌患者60例,分为2组,对照组30例仅给予单纯调强放疗,观察组30例给予紫杉醇联合奈达铂化疗同步适形调强放疗,比较观察2组的疗效和安全性。结果观察组总有效率为96.7％,明显高于对照组的80.0％,差异有统计学意义（P ﹤0.05）。观察组毒副反应以恶心呕吐和Ⅰ、Ⅱ度骨髓抑制为主,对照组以放射性肺炎、放射性食管炎为主。结论局部晚期食管癌采用紫杉醇联合奈达铂化疗同步适形调强放疗治疗,疗效好,安全性高。     

三维适行放疗同期多西紫杉醇和顺铂化疗治疗中晚期食管癌的临床观察

目的 探讨三维适行放疗同期多西紫杉醇和顺铂化疗治疗中晚期食管癌的疗效及毒副反应.方法 68例中晚期食管癌患者随机分为2组,观察组35例接受三维适形放疗同期联合多西紫杉醇和顺铂化疗,对照组33例患者仅接受三维适形放疗.结果 观察组总有效率为82.9%,对照组为69.7%（P〈0.05）.观察组1、2 a生存率分别为68.6%,40.0%,对照组分别为60.6%,30.3%,2组生存率曲线差异有统计学意义（P〈0.05）.结论 三维适行放疗同期多西紫杉醇和顺铂化疗能提高中晚期食管癌的近期疗效,延长生存期,且毒副反应可耐受.     

奥沙利铂联合三维适形放疗治疗老年晚期食管癌的临床观察

目的 观察奥沙利铂联合三维适形放疗治疗老年晚期食管癌的疗效和毒副反应.方法 80例老年晚期食管癌随机分为两组,试验组给予奥沙利铂化疗和三维适形放疗,而对照组仅给予三维适形放疗.治疗结束后两组分别评价疗效和毒副反应.结果 试验组有效率为90.0%,对照组为72.5%,差异有统计学意义(P＜0.05).试验组和对照组1、2...     

三维适形放疗联合替吉奥与奈达铂同步化疗治疗局部晚期食管癌的近期疗效评价

目的:探讨三维适形放疗联合替吉奥与奈达铂同步化疗治疗局部晚期食管癌的近期疗效及毒副反应。方法:对我科自2010年9月至2011年6月收治的60例符合入组条件的食管癌患者随机分为2组,所有患者均采用三维适形放射治疗技术,常规分割,总剂量60-66Gy,6-7周完成放疗计划。同步化疗组给予替吉奥80mg/m2,d1-d14,奈达铂90mg/m2,d1,每4周重复。结果:1例失访,59例可评价疗效及毒副反应。随访时间至放疗结束后3月。同步化疗及单纯放疗组RR(PR+CR)分别为86.2%,63.3%,差异具有统计学意义。主要毒副反应为骨髓抑制及放射性食管炎。毒副反应同步化疗组较单纯放疗组多见,经积极处理所有患者均完成治疗计划。结论:三维适形放疗联合替吉奥与奈达铂同步化疗治疗局部晚期食管癌较单纯放疗近期疗效显著提高,毒副反应可以耐受,该方案的远期效果有待进一步观察。     

放疗同期联合奈达铂治疗中晚期食管癌临床观察

目的：观察放疗同期联合奈达铂化疗治疗中晚期食管癌的疗效及毒副反应。方法：57例中晚期食管癌患者随机分成实验组和对照组。对照组予三维适形放疗,2Gy/次,5次/周,总量60-66Gy。实验组与三维适形放疗同步行奈达铂化疗,30mg/m2静脉滴注,每周1次,共6次。治疗结束后3个月评价近期疗效和毒副反应。随访后评价远期疗效。结果：实验组有效率79.3%高于对照组53.6%（P〈0.05）。实验组1年生存率为78.2%,对照组为67.3%（P〈0.05）。实验组主要毒副反应为骨髓抑制,但均可耐受。结论：奈达铂单药联合三维适形放疗能明显改善中晚期食管癌患者疗效,虽不良反应增加但可以耐受。     

三维适形放疗联合周剂量奈达铂治疗老年非小细胞肺癌的临床观察

目的：探讨三维适形放疗联合周剂量奈达铂治疗老年非小细胞肺癌（ NSCLC）的疗效及毒副反应。方法选择63例老年NSCLC患者,随机分为2组,其中观察组31例,对照组32例,均予三维适形放疗,观察组同步进行周剂量奈达铂化疗。结果观察组、对照组疾病控制率分别为80.6%和68.6%;1 a生存率分别为77.4%和68.8%。2组主要毒副反应为急性放射性肺炎、支气管炎,急性放射性食管炎,骨髓抑制等。结论三维适形放疗联合周剂量奈达铂治疗老年NSCLC疗效较好,毒副反应可耐受。     

奈达铂和氟尿嘧啶化疗联合同步放疗治疗Ⅲ、Ⅳa期鼻咽癌临床分析

目的:评价奈达铂和氟尿嘧啶化疗联合同步放疗治疗Ⅲ、Ⅳa期鼻咽癌的局控率、生存率和毒副反应。方法:回顾性分析奈达铂 氟尿嘧啶化疗联合同步放疗治疗Ⅲ、Ⅳa期鼻咽癌30例的局控率、生存率和毒副反应,并与单纯放疗30例相比较。结果:CR率放化组为93.33%,单放组为73.33%,两组比较差异有统计学意义(P<0.05);1年无复发生存率和1年无远处转移生存率放化组分别为93.33%和86.67%,单放组分别为83.33%和73.33%,两组比较差异无统计学意义(P>0.05);治疗毒副反应:放化组恶心呕吐高于单放组,主要是轻中度,差异有统计学意义(P<0.05);放化组骨髓抑制较单放组明显(P<0.05),且放化组有1例在第3周期化疗后发生Ⅳ度血小板下降;放化组皮肤反应无明显加重(P>0.05),但Ⅲ、Ⅳ度口腔黏膜反应与单放组比较差异有统计学意义(P<0.05)。结论:奈达铂 氟尿嘧啶同期放化疗治疗Ⅲ、Ⅳa期鼻咽癌近期疗效确切,毒副反应较低,患者耐受性良好。     

三维适形放疗同步应用铂金属和紫杉醇对食管癌的临床疗效

目的比较奈达铂和紫杉醇同步放疗、奈达铂同步放疗和顺铂同步放疗治疗食管癌的疗效和不良反应。方法将92例食管癌患者随机分为奈达铂和紫杉醇同步放疗组(A组)、奈达铂同步放疗组(B组)和顺铂同步放疗组(C组)。均采用加速器6MV的X线三维适形放疗,总剂量60～70 Gy。A组放疗同时每3周应用紫杉醇135 mg/m2(d1)和奈达铂25 mg/m2(d1～3)化疗,至放疗结束;B组放疗同时每3周应用奈达铂30 mg/m2(d1～3)化疗,至放疗结束;C组放疗同时每3周应用顺铂30 mg/m2(d1～3)化疗,至放疗结束。结果奈达铂和紫杉醇同步放疗能有效提高近期疗效和远期疗效,但不良反应较重。奈达铂同步放疗方案与顺铂同步放疗方案比较,近期疗效和2年生存率有所提高,胃肠道反应也轻,但骨髓抑制反应较严重。结论奈达铂和紫杉醇同步放疗对中晚期食管癌的疗效较好,不良反应可耐受。     

周剂量用紫杉醇同步三维适形放疗治疗老年局部晚期非小细胞肺癌的临床研究

目的 评价周剂量用紫杉醇同步三维适形放疗治疗老年局部晚期非小细胞肺癌的疗效和毒副反应.方法 57例随机分为两组.化放组在三维适形放疗同时行化疗,紫杉醇60 mg/m2,静脉滴注,1次/周,连用3周,休息1周,共使用6周;单纯放疗组:三维适形放疗.结果 化放组:CR率12.2%,PR率44.8%,总有效率(CR+PR)为57.0%;单放组:CR率14.3%,PR率25.0%,总有效率为39.3%,两组比较差异有统计学意义(P<0.05).化放组和单放组的1、2年生存率分别为65.5%、34.5%和53.5%、28.0%,中位生存时间分别为16个月和10.2个月,差异有统计学意义(P<0.01).结论 周剂量用紫杉醇联合三维适形放疗同步治疗老年局部晚期非小细胞肺癌安全有效,值得进一步临床研究.     

奈达铂和氟尿嘧啶化疗联合同步放疗治疗Ⅲ、Ⅳa期鼻咽癌临床分析

目的：评价奈达铂和氟尿嘧啶化疗联合同步放疗治疗Ⅲ、Ⅳa期鼻咽癌的局控率、生存率和毒副反应。方法：回顾性分析奈达铂＋氟尿嘧啶化疗联合同步放疗治疗Ⅲ、Ⅳa期鼻咽癌30例的局控率、生存率和毒副反应,并与单纯放疗30例相比较。结果：CR率放化组为93.33%,单放组为73.33%,两组比较差异有统计学意义（P〈0.05）;1年无复发生存率和1年无远处转移生存率放化组分别为93.33%和86.67%,单放组分别为83.33%和73.33%,两组比较差异无统计学意义（P〉0.05）;治疗毒副反应：放化组恶心呕吐高于单放组,主要是轻中度,差异有统计学意义（P〈0.05）;放化组骨髓抑制较单放组明显（P〈0.05）,且放化组有1例在第3周期化疗后发生Ⅳ度血小板下降;放化组皮肤反应无明显加重（P〉0.05）,但Ⅲ、Ⅳ度口腔黏膜反应与单放组比较差异有统计学意义（P〈0.05）。结论：奈达铂＋氟尿嘧啶同期放化疗治疗Ⅲ、Ⅳa期鼻咽癌近期疗效确切,毒副反应较低,患者耐受性良好。     

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.     

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.     

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     

奥沙利铂联合羟基喜树碱治疗晚期胃癌临床分析

背景与目的体外及体内的临床研究显示,奥沙利铂(L-OHP)对多种肿瘤有显著抑制作用并与绝大多数抗癌药物具有相加或协同细胞毒作用.本文旨在观察L-OHP联合羟基喜树碱(HCPT)治疗晚期胃癌的近期疗效和患者耐受性,并与传统的化疗方案进行对比.方法采用非随机的分组方法将43例晚期胃癌患者分为L-OHP+HCPT方案组(治疗组)与Vp-16+CF+5-FU(ELF)方案组(对照组),其中男性28例,女性15例,中位年龄59岁,KPS评分≥60,观察两组的近期疗效和患者耐受性.结果治疗组24例有效率58.3%(14/24),对照组19例有效率42.1%(8/19).治疗组有效率高于对照组,两组差异有显著性(P<0.05).两组不良反应主要是骨髓抑制、恶心、呕吐、口腔炎、周围神经炎、静脉炎、脱发等,均在Ⅰ、Ⅱ度范围内.结论L-OHP联合HCPT方案治疗晚期胃癌疗效较好,不良反应可以耐受.     

Varicella-Zoster Virus Prophylaxis with Low-Dose Acyclovir in Patients with Multiple Myeloma Treated with Bortezomib

BackgroundVaricella-zoster virus (VZV) reactivation is a common complication in patients with multiple myeloma (MM) treated with bortezomib, with an incidence rate of 10%-60%. The aim of our study was to analyze the effect of acyclovir prophylaxis in this patient population.Patients and MethodsWe studied 98 consecutive patients with relapsed MM treated with bortezomib. Bortezomib 1.3 mg/m² was given on days 1, 4, 8, and 11 of a 21-day cycle. At first, patients did not receive any VZV prophylaxis, but because of the high incidence of VZV reactivation, VZV prophylaxis with acyclovir was implemented subsequently.ResultsA total of 11 patients treated with bortezomib did not have any VZV prophylaxis, and 4 of these 11 patients (36%) developed VZV reactivation in the form of herpes zoster. No VZV reactivations were observed in the 32 patients who received acyclovir 400 mg 3 times daily or the 55 patients who received acyclovir in a dose reduced to 400 mg once daily during bortezomib treatment.ConclusionVaricellazoster virus reactivation is a common and serious adverse effect of bortezomib treatment. Acyclovir 400 mg once daily is sufficient to protect from VZV reactivation in patients with MM treated with bortezomib.