高聚生瘤内注射在复发性鼻咽癌再放疗中的应用价值

目的：研究高聚生瘤体内注射配合放射治疗复发性鼻咽癌并颈部淋巴结转移的临床使用价值。方法：41例患者采用高聚生瘤体内注射联合肌注配合放射治疗、照射剂量DT65—70Gy／6．5—7周。观察其近、远期疗效、不良反应等。结果：治疗结束后鼻咽病灶41例中CR18例，占43．9％，PR17例，占41．5％，NC6例，占14．6％，PD室0例。总有效率（CR＋PR）为85．4％。颈部淋巴结肿块41例次，其中CR17例，占41．5％，PR19例，占46．3％，NC5例，占12．2％，PD0例。总有效率（CR＋PR）为87．8％。其中两处均出现CR的共有16例，占39．0％（16／41）。1年生存率为80．48％（33／41），2年生存率为62．50％（25／40），3年生存率为47．50％（19／40）。3年远处转移发生率为7．3％（3／41）。结论：高聚生瘤体内注射联合肌注，可使瘤体内该药物浓度增高，配合放射治疗、增强了对肿瘤细胞的直接杀伤作用，具有较高的肿瘤消退率、远期生存率并且改善了患者的生存质量。     

鞘内注射甲氨蝶呤和地塞米松治疗小细胞肺癌脑转移

目的 :探讨鞘内注射联合全身化疗和单纯全身化疗治疗小细胞肺癌 (smallcelllungcancer ,SCLC)脑转移的疗效和毒性。方法 :68例SCLC脑转移患者随机抽样分为治疗组 3 2例和对照组 3 6例 ,两组患者特征具有可比性 ,P >0 0 5。结果 :治疗组CR 12例 ,PR 8例 ,NC 6例 ,PD 6例 ,中位生存期 12 6个月 ,1年生存率 5 6 3 %(18/3 2 )。对照组CR 0例 ,PR 12例 ,NC16例 ,PD 8例 ,中位生存期 8 8个月 ,1年生存率 2 2 2 % (8/3 6)。两组治疗有效率、中位生存期和 1年生存率差异有统计学意义 ,P <0 0 5。毒副反应差异无统计学意义 ,P >0 0 5。结论 :鞘内注射甲氨蝶呤和地塞米松联合全身化疗 ,不仅有效缓解了肺部症状 ,而且颅内转移瘤缓解率高 ,大大提高了生存率和生活质量     

经皮肺穿刺瘤体内低渗化疗治疗非小细胞肺癌的临床研究

 目的 观察经皮肺穿刺瘤体内注射低渗化疗液配合全身化疗治疗非小细胞肺癌（NSCLC）的近期疗效。方法 86例NSCLC患者随机分为治疗组与对照组，治疗组44例，在MVP方案全身化疗的同时，给予经皮肺穿刺瘤体内注射平阳霉素加蒸馏水（低渗液）；对照组42例，单纯给予MVP方案全身化疗。两组均21d为1周期，治疗2周期以上评价疗效。结果 治疗组CR 5例，PR 26例，NC 10例，PD 3例，总有效率为70.5 %（31／44）；对照组CR 1例，PR 15例，NC 18例，PD 8例，总有效率为38.1 %（16／42）。两组疗效比较差异有统计学意义（χ2 = 9.08，P＜0.01）。治疗组与对照组的消化道反应及骨髓抑制相似，治疗组有6例患者出现发热，12例患者出现局部疼痛，均轻微，对症处理后好转，无其他毒副反应发生。结论 经皮肺穿刺瘤体内低渗化疗治疗NSCLC疗效好，毒副作用小，操作简单，值得临床推广应用。     

原发性肝癌适形放射治疗配合热疗近期疗效观察

[目的]探讨并评价适形放射治疗配合内生场热疗治疗原发性肝癌的近期疗效。[方法]66例原发性肝癌患者行适形放射治疗,其中36例配合使用长春产NRL-001型内生场肿瘤热疗系统,并采用直肠内替代测温方法。[结果]单纯适形放射治疗:AFP恢复正常者10例(50%);肿瘤最大径小于8cm者(22例),其中CR7例(31.8%),PR11例(50.0%),NC3例(13.6%),PD1例(4.5%);肿瘤最大径大于8cm者(8例),其中CR1例(12.5%),PR2例(25.0%),NC3例(37.5%),PD2例(25.0%);1年生存率:Ⅰ期71.4%(15/21),Ⅱ期33.3%(3/9);并发症26例。适形放射治疗配合内生场热疗AFP恢复正常者21例(80.8%);肿瘤最大径小于8cm者(28例),其中CR14例(50.0%),PR12例(42.9%),NC2例(7.1%);肿瘤最大径大于8cm者(8例),其中CR1例(12.5%),PR3例(37.5%),NC3例(37.5%),PD1例(12.5%);1年生存率:Ⅰ期85.2%(23/27),Ⅱ期55.6%(5/9);并发症17例。[结论]适形放射治疗配合内生场热疗治疗原发性肝癌疗效好,副反应少,临床应用价值高。     

三维适形低分割放射治疗老年非小细胞肺癌疗效观察

目的　探讨三维适形低分割放射治疗老年非小细胞肺癌的疗效。方法　 4 5例患者均采用低分割治疗 ,处方剂量为 4～ 5Gy,隔日 1次 ,总量 4 8～ 5 5Gy。结果　CR 2 3例 ( 5 1.1% ) ,PR 15例( 33.3% ) ,NC 5例 ( 11.1% ) ,PD 2例 ( 4 .4 % ) ,RR 38例 ( 84 .4 % )。 1、2、3年生存率分别为 6 6 .7%、4 8.9%、39.1%。结论　三维适形放射治疗对于老年非小细胞肺癌是一种反应较小 ,痛苦较轻 ,安全有效的治疗措施     

去甲长春花碱、多西紫杉醇、吉西他滨治疗晚期非小细胞肺癌

目的　观察去甲长春花碱 (Vinorelbine商品名 :诺维本Navelbine ,NVB) ,多西紫杉醇 (Docetaxel商品名 :泰索帝 ) ,吉西他滨(Gemcitabine商品名 :健择 )分别联合顺铂 (Cisplatin)治疗晚期非小细胞肺癌的疗效及其毒副反应。方法　 95例晚期非小细胞肺癌患者分别接受由诺维本、泰索帝、健择联合顺铂 (NP、DP、GP)组成的方案 ,其中NP方案 35例 ,DP、GP方案均分别为 30例 ,三组间患者特征具有可比性。结果　NP组中 ,无CR病例 ,PR4 2 .9% ,NC4 0 % ,PD17.1%RR4 2 .9% ;DP组中CR3.3% ,PR4 0 % ,NC4 0 % ,PD16 .7% ,RR4 3.3% ;GP组中CR无 ,PR4 6 .7% ,NC4 0 % ,PD13.3% ,RR4 6 .7%。其毒副反应 :主要均为血液学毒性 ,其中 ,NP组和DP组以白细胞减少为主 ,GP组以血小板减少为主。结论　NP、DP、GP方案治疗晚期非小细胞肺癌疗效相似 ,其主要毒副反应是骨髓抑制 ,但均可耐受。     

多西他赛联合顺铂、5-Fu治疗进展期胃癌疗效分析

目的 观察多西他赛联合顺铂,5-Fu治疗进展期胃癌疗效及毒副作用.方法 32例进展期胃癌采用多西他赛联合顺铂,5-Fu方案治疗2-3周期.按照WHO标准进行评价.结果 32例中CR 1例,PR 14例,NC 10例,PD 7例,总有效率(RR)为46.8%(15/32);初治组RR为57.14%(3/7);复治组RR为34.38%(11/25).两组RR比较差异有统计学意义(P=0.04).结论 多西他赛联合顺铂,5-Fu治疗进展期胃癌疗效确切,毒副作用可以耐受,可广泛应用.     

三维适形放射治疗肝癌55例疗效分析

目的 观察评价三维适形放射治疗技术(3-DCRT)治疗原发及继发性肝癌的治疗疗效.方法 1998年11月至2007年12月对55例原发及继发性肝癌患者进行3-DCRT治疗,总剂量DT 45～60Gy/15～30F,3～6w,正常肝组织V30＜33%.结果 55例患者中,CR 6例(10.9%),PR 26例(47.3%),NC 15例(27.3%),PD 8例(14.5%),总有效率(CR+PR)58.2%.1、2、3年生存率分别为67.3%(37/55)、34.9%(15/43)、23.3%(7/30).结论 3-DCRT治疗肝癌安全有效,毒副反应小.     

腹腔内联合灌注化疗治疗恶性腹膜间皮瘤的临床研究

目的探讨腹腔内联合化疗治疗恶性腹膜间皮瘤(malignant peritoneal mes-othelioma,MPM)的疗效。方法采用多柔比星30mg/m2+顺铂25mg/m2+丝裂霉素4～6mg联合化疗方案对19例MPM患者进行腹腔内注射,每周1次,每例共注射3～4次,分析腹水变化情况。结果近期疗效CR10例(52.6%),PR6例(31.6%),NC3例(15.8%),有效率(CR+PR)为84.2%,显著高于对照组(41.7%),χ2=6.09187,P<0.025。不良反应轻微。结论腹腔内联合化疗治疗MPM近期疗效好,不良反应少,是MPM的有效治疗方法之一。     

顺铂腹腔灌注化疗联合静脉化疗治疗进展期胃肠道肿瘤近期疗效观察

为观察并评价顺铂(DDP)腹腔灌注化疗联合静脉化疗治疗进展期胃肠道肿瘤的近期疗效和不良反应,将54例进展期胃肠道肿瘤患者分成两组:单纯化疗组26例,其中胃癌14例采用HELF方案,大肠癌12例采用OLF方案;联合组28例,其中胃癌15例,大肠癌13例,先给予DDP腹腔灌注化疗,1周后加静脉化疗。静脉化疗方案同单纯化疗组。结果示,单纯化疗组CR1例,PR7例,NC10例,PD8例,有效率为30.8%(8/26);联合组CR2例,PR15例,NC7例,PD4例,有效率为60.7%(17/28)。治疗后的不良反应主要为消化系统毒性及骨髓抑制。初步研究结果提示,DDP腹腔灌注化疗联合静脉化疗治疗进展期胃肠道肿瘤近期疗效显著,值得临床研究。     

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.     

Second-line chemotherapy with cisplatin-ifosfamide in patients with ovarian cancer previously treated with carboplatin-cyclophosphamide.

In an effort to use antineoplastic drug combinations which are active in platinum resistant ovarian cancer or which can induce a second response after a platinum first-line treatment, we conducted a study on 30 ovarian cancer patients previously treated with carboplatin plus cyclophosphamide who were given ifosfamide 5 g/m2 i.v. divided over days 1 to 3 plus mesma combined with cisplatin 100 mg/m2 i.v. divided over days 1 to 3 every 4 weeks as second-line treatment. Eight patients had never entered remission with first-line chemotherapy while 22 patients had tumor recurrence within 6 to 18 months after the end of chemotherapy and their tumors were considered potentially platinum sensitive. Responding patients received 6 courses while palliative treatment for nonresponders was provided. Of the 22 patients with tumor recurrence, 8 patients responded with one partial response (PR) and 7 complete clinical responses (CCR). Two out of the 8 patients with platinum resistant disease demonstrated short lasting PR. Seven patients with CCR underwent second-look operation and in two a pathological CR was documented. Median time to progression was 6 mo (4-12). The median overall survival was 12 mo (4-20). Myelotoxicity despite G-CSF administration was significant with grade 4 leukopenia in 40% and grade 3 thrombocytopenia in 20% of patients. Central nervous system (CNS) toxicity was significant with 30% somnolence, 20% disorientation and an episode of grand-mal epilepsy ascribed to ifosfamide. With a 33% response rate the combination is as effective as new agents employed in relapsed ovarian cancer. Platinum-refractory disease may respond to a lesser degree. The most important determinant of response was the progression-free interval from first-line chemotherapy. Whether patients recurring after carboplatin plus cyclophosphamide have a greater chance to respond to cisplatin plus ifosfamide or vice-versa cannot be supported by the current data and therefore randomized studies should be performed to this end.     

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.